| Test |
Cost* |
Frequency and Comment |
| HBsAg** |
$20 to $25 |
Screen for chronic hepatitis B. Consider HBV DNA in HBsAg negatives with abnormal transaminases. |
| anti-HCV** |
$25 HCV
EIA |
Screen with anti-HCV; confirm positives with quantitative HCV RNA at $150. Consider HCV RNA in HCV- seronegatives at high risk, with abnormal transaminases, or with CD4 counts <200. |
Syphilis – VDRL, RPR or treponema
EIA** |
$5 to $16 |
Confirm positives with FTA-ABS, MHA-TP or TPPA. Repeat test annually in at risk sexually active patients. Note concerns with EIA screening (pg 48). |
anti-Toxoplasma
IgG** |
$12 to $15 |
Screen all patients at baseline, and repeat in sero - negatives if CD4 cell count is ≤100 cells/mm3 and patient does not take TMP-SMX for PCP prophylaxis or has symp toms suggestive of toxoplasmosis encephalitis. Agglutin ation assays for IgG are preferred. IgM is not useful. |
| Varicella IgG* |
|
If negative or unknown history for chickenpox and shingles to promote protection against exposure, varicella vaccination and/or post-exposure ZIG. |
| Chemistry |
Comprehensive
Chemistry
panel** |
$10 to $15 |
Includes liver enzymes and renal function. Repeat every 6-12 months or more frequently in patients with abnormal results and with administration of hepatotoxic or nephrotoxic drugs, including most ART regimens. |
| G6-PD |
$14 to $20 |
Test: 1) Susceptible hosts: Primarily men (X-linked), with the following ancestry African-American, Italian, Sephardic Jew, Arab, and those from India and Southeast Asia; 2) Those with drug-induced hemolysis should be tested following recovery (see pg 57). Options are testing susceptible patients at baseline or before use of oxidant drugs – Risks include primaquine > dapsone >sulfonamides. |
Lipid profile and
blood glucose
(fasting) |
$20 to $40 |
Therapeutic monitoring recommended for patients receiving antiretroviral. Test at baseline and at 3 to 6 months post HAART with subsequent measurements annually or more frequently based on initial results and risks.** |
| Hematology |
Complete blood
count (CBC)** |
$6 to $8 |
Repeat every 3 to 6 months, more frequently for low values and with marrow-toxic drugs. |
CD4 cell count
and CD4%** |
$60 to $150 |
Repeat every 3 to 6 months and repeat for discordant results, including with results that are inconsistent with prior trends. Routine testing when counts are <50 cells/mm3 is of minimal use except for monitoring response to antiretroviral therapy. |
| Other |
| Chest x-ray |
$40 to $140 |
May be routine or restricted to those with past pulmonary disease, chronic pulmonary disease or a positive PPD* |
| PAP smear** |
$25 to $40 |
Repeat at 6 months and then annually if results are normal. Results reported as “inadequate” should be repeated. Refer to a gynecologist for results showing atypia or greater on the Bethesda scale (see pg 51-53). |
TABLE 2-16:
