Basic Evaluation for Newly Diagnosed HIV/AIDS Patients
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Basic Evaluation for Newly Diagnosed HIV/AIDS Patients

 • CD4 count, VL, genotype/resistance testing, CBC w/diff, BMP, U/A, LFTs, lipase, A1c/FLP, Hep A/B/C, hCG, cervical and/or anal pap, RPR, GC/CT, PPD or IGRA; CMV, VZV, toxo, mycobacterial BCx if CD4 < 100, dilated eye exam if CD4<50

 • Initiate ARV early through referral (p36222) at all CD4 levels to decrease mortality In many cases, ART can be initiated on site, even prior to genotype return, even in high-risk patients. Make sure ID is involved in this decision.

Treatment for ARV-Naïve Patients many options, choose based on indiv pt factors, drug-drug interactions, resistance testing

 • 1st line: 2 NRTI “backbone” (typically TAF/FTC or TDF/FTC [Truvada]) + 1 from diff. class, typically integrase inhibitor

Hospital Management of HIV/AIDS Patients:

 • If patient is on ART: determine regimen & adherence; typically continue ARVs (interruptions can ↑ disease progression)

     o If must hold ARVs because of significant non-adherence or recent severe adverse reaction, hold all ARVs and consult ID

     o Beware of drug-drug interactions, particularly with boosted PIs (e.g. PPIs, check http://arv.ucsf.edu/insite?page=ar-00-02)

 • If patient not yet on ART: prioritize OI tx, ppx, consult ID for help on early inpt vs outpt initiation of ART

 • IRIS: worsening sx of underlying infx (TB, MAC, CMV, others) 1-3 mos post-ART initiation, high risk if low CD4 count

     o Nevertheless, early ARV init safe after OI dx, except in crypto meningitis 



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