Laboratory Monitoring after Initiating Antiretroviral Therapy

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Last updated March 27, 2015
Case Authors: 
David H. Spach, MD's picture
David H. Spach, MD
Professor of Medicine
Division of Infectious Diseases
Clinical Director
Northwest AIDS Education and Training Center
University of Washington School of Medicine 
Learning Objectives: 
  1. Discuss appropriate monitoring of CD4 cell counts and HIV RNA levels after starting antiretroviral therapy.
  2. Summarize the approach for laboratory monitoring for potential toxicity with antiretroviral medications.

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References
  1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Laboratory testing: Plasma HIV-1 RNA (Viral Load) and CD4 Count Monitoring. May 1, 2014.
  2. Perelson AS, Essunger P, Cao Y, et al. Decay characteristics of HIV-1-infected compartments during combination therapy. Nature. 1997;387:188-91.
  3. Yamashita TE, Phair JP, Muñoz A, et al. Immunologic and virologic response to highly active antiretroviral therapy in the Multicenter AIDS Cohort Study. AIDS. 2001;15:735-46.
  4. Le Moing V, Thiébaut R, Chêne G, et al. Predictors of long-term increase in CD4(+) cell counts in human immunodeficiency virus-infected patients receiving a protease inhibitor-containing antiretroviral regimen. J Infect Dis. 2002;185:471-80.
  5. Hyle EP, Sax PE, Walensky RP. Potential savings by reduced CD4 monitoring in stable patients with HIV receiving antiretroviral therapy. JAMA Intern Med. 2013;173:1746-8.
  6. Gale HB, Gitterman SR, Hoffman HJ, et al. Is frequent CD4+ T-lymphocyte count monitoring necessary for persons with counts ≥300 cells/μL and HIV-1 suppression? Clin Infect Dis. 2013;56:1340-3.
  7. Spritzler J, Mildvan D, Russo A, et al. Can immune markers predict subsequent discordance between immunologic and virologic responses to antiretroviral therapy? Adult AIDS Clinical Trials Group. Clin Infect Dis. 2003;37:551-8.
  8. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Laboratory testing: Laboratory Testing for Initial Assessment and Monitoring while on Antiretroviral Therapy. May 1, 2014.
  9. Aberg JA, Gallant JE, Ghanem KG, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis. 2013;58:e1-34. 
  10. Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2005;40:1559-85.