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3 Monitoring

 TestBaselineBefore ARV InitiationAfter ARV InitiationAfter 2 years, clinically stable, pVL<40 copies/mL, good ARV adherenceMore info
Adherence   Every clinic visit Every clinic visit Annually  
CD4 Count CD4 count, absolute and percentage Every 3 – 4 months Monthly until pVL <40 copies/mL then every 3 – 4 months. every 6 months; optional if CD4 ​>​350 cells mm³  
Drug Level Monitoring Therapeutic Drug Monitoring     Select clinical situations eg. kidney/liver impairment, drug–drug interactions, virologic failure without resistance, pregnancy. Select clinical situations eg. kidney/liver impairment, drug–drug interactions, virologic failure without resistance, pregnancy. Drug Level Monitoring
Fasting Blood Glucose and Lipid Profile Fasting glucose or glycated hemoglobin (HbA1C), Total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, or apoB Annually if stable With first PVL (after 1 month), then every 6 months every 6 months  
Hematologic Assessment CBC with Differential, Platelet count Every 3 – 4 months With first PVL (after 1 month) then every 3 – 4 months every 6 months  
Liver Enzymes & LFTs ALT, AST, Total bilirubin, INR Annually if stable With first PVL (after 1 month) then every 3 – 4 months every 6 months  
Renal Function Blood pressure, Creatinine, eGFR, Serum phosphate, Urinalysis, Spot urine ACR or PCR Annually if stable; increase frequency if baseline renal dysfunction or high risk of chronic kidney disease With first PVL (after 1 month) then every 3 – 4 months; increase frequency if baseline renal dysfunction or high risk of chronic kidney disease every 6 months; increase frequency if baseline renal dysfunction or high risk of chronic kidney disease  
Drug Resistance Testing HIV genotypic drug resistance At the time of first pVL; performed on stored plasma sample Shortly before ARV initiation Test if pVL rebounds (to >250 copies/mL) after initial suppression or pVL fails to suppress to <250 copies/mL Test if pVL rebounds to >250 copies/mL Drug resistance testing
Screen For Risk Of ABC HSR HLA-B*5701 Before initiating or restarting therapy with abacavir, if not previously done. Test patients not previously screened and currently taking abacavir Test patients not previously screened and currently taking abacavir HLA-B*5701
Tropism Testing Coreceptor tropism testing   When considering a CCR5 antagonist When considering a CCR5 antagonist as an ARV switch or for treatment failure When considering a CCR5 antagonist as an ARV switch CCR5 Tropism Testing
HIV Plasma Viral Load (pVL) Quantitative plasma HIV RNA Every 3 – 4 months Monthly until pVL <40 copies/mL then every 3 – 4 months. every 6 months  

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