Initial evaluation of the HIV-infected adult
- Howard Libman, MD
Howard Libman, MD
- Deputy Editor — Primary Care
- Professor of Medicine, Emeritus, Harvard Medical School
- Todd M Pollack, MD
Todd M Pollack, MD
- Instructor in Medicine, Part-time
- Harvard Medical School
The initial evaluation of the HIV-infected adult is comprehensive and may take place over several visits. Its goals are to assess the stage of HIV disease, determine the risk for other infections, identify co-morbidities that are associated with HIV infection, and evaluate for the initiation and selection of antiretroviral therapy. In addition, the initial evaluation is an important time to establish the patient-practitioner relationship and educate the patient about the natural history and management of HIV infection.
This topic discusses the elements of the initial evaluation of patients with HIV infection. Primary care of the HIV-infected patient is discussed elsewhere. (See "Primary care of the HIV-infected adult".)
In the United States, the HIV Medicine Association of the Infectious Diseases Society of America has published guidelines on the primary care of HIV-infected individuals, which were last updated in 2013 . The recommendations discussed in this topic are generally consistent with these guidelines.
ESTABLISHING THE DIAGNOSIS
Patients with a prior history of HIV infection — In patients who present at their initial visit with a prior history of HIV infection, efforts should be made to obtain documentation of HIV antibody or HIV RNA testing in the past. If these records are not available, repeat HIV antibody testing should be performed to confirm the diagnosis since cases of factitious HIV infection have been reported . (See 'HIV serology' below.)
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- ESTABLISHING THE DIAGNOSIS
- Patients with a prior history of HIV infection
- Patients with suspected HIV infection
- History of infection
- Past medical history
- Medications and allergies
- Immunization history
- Social history
- Family history
- Review of systems
- PHYSICAL EXAMINATION
- INITIAL LABORATORY TESTING
- HIV-related testing
- - HIV serology
- - CD4 cell count and percentage
- - Viral load
- - Resistance testing
- - Additional tests to inform ART selection
- General blood and urine testing
- - Complete blood count
- - Renal function
- - Hepatic function
- - Glucose and lipid profile
- Screening for co-infections
- - Viral hepatitis
- - Tuberculosis
- - Sexually transmitted infections
- - CMV and VZV
- - Toxoplasma
- Screening for HPV-associated neoplasia
- - Cervical cancer
- - Anal cancer
- Select testing
- - G6PD deficiency
- - Bone mineral density testing
- EVALUATION FOR ANTIRETROVIRAL THERAPY
- PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS
- RISK REDUCTION COUNSELING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS