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announced in June, 2008 and is now standard.This assay appears to detect X4 virus present at levels of 0.3%, a 30 fold increase from the earlier version (Reeves J. 15th CROI 2008.Abstr. 869). 

SCREENING LABORATORY TESTS

The usual screening battery advocated for patients with established HIV infection is summarized in table 2-15, pg 46-48 (Primary Care Guidelines IDSA, CID 2004;39:609).

Complete Blood Count: The CBC is important, because anemia, leukopenia, lymphopenia and thrombocytopenia are common due to HIV per se or to medications (JAIDS 1994;7:1134; JAIDS 2001;28:221). Repeat at 3- to 6-month intervals and more frequently in patients with symptoms (headache, fatigue), those receiving marrow-suppressing drugs such

TABLE 2-16:

Routine Laboratory Tests
Test Cost* Frequency and Comment
HIV Tests
HIV confirmation $100 HIV serology. Rapid HIV tests nd EIA need confirmation
by Western blot, IFA or HIV RNA. If confirmatory test is
negative or indeterminant: Repeat in 1 month. See pg
9-18.
HIV viral load   See pg 18-24. Baseline and every 3-4 months.
CD4 count and
%		   See pg 24-29. Baseline and every 3-4 months.. Some
experts recommend two tests due to large variations
and importance in clinical decisions
HIV genotypic
resistance test		 $100-150 Done at baseline with or without plan for ART. See pg
29-34. Obtain at initial evaluation as treatment and with
virologic failure.
HLA-B*5701 $100 Indicated only with plan to treat with ABC.
Tropism test $1960 Indicated only with plan to use CCR5 antagonist such
asMVC and with MVC failure
Serologic Tests
Hepatitis screen $60 to $80 If acute hepatitis suspected, screen with anti-HAV
IgM, anti-HCV and HBsAg ± anti-HBc lgM. For chronic
hepatitis and immune status: anti-HAV, anti-HCV,
HBsAg, anti-HBs and anti-HBc.
Total anti-HAV
antibody**		 $20 to $30 Screen at baseline for HAV immunity to determine
need for vaccination.
anti-HBc or
anti-HBs**		 $10 to $15 HBV: Screen at baseline for immunity with anti-HBc or
anti-HBs to determine need for vaccination. If prior HBV
vaccination, then test anti-HBs. If anti-HBc present
without anti-HBs or HBsAg, screen for chronic HBV
with HBV DNA; if HBV DNA negative, give HBV
vaccine.Repeat anti-hbs at 1-2 months after 3d vaccine
dose to determine "take" (see pg 54).

 

2007 © John G. Bartlett, M.D. All rights reserved.46

Chapter 2: Laboratory Tests

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