From the Guidelines
For a 22-year-old male with HIV on Biktarvy returning for a 3-month follow-up, the most crucial laboratory tests and evaluations include a CD4 count, HIV viral load, complete blood count, comprehensive metabolic panel, lipid panel, and urinalysis, as well as screenings for sexually transmitted infections, tuberculosis, and hepatitis B and C if not previously done, according to the 2020 recommendations of the International Antiviral Society-USA panel 1.
Initial Assessment
When initiating antiretroviral therapy (ART), it is essential to characterize the HIV stage using HIV RNA level and CD4 cell count, assess general health through kidney and liver function tests, lipid levels, complete blood cell count, blood glucose level, and pregnancy test, and screen for co-infections such as viral hepatitis A, hepatitis B, hepatitis C, tuberculosis, and sexually transmitted infections (STIs) 1.
Ongoing Monitoring
During ART, monitoring should include adherence and tolerability of therapy along with the measurement of HIV RNA level within 6 weeks of starting ART 1.
Laboratory Tests
Key laboratory tests include:
- CD4 count and HIV viral load to assess treatment effectiveness
- Complete blood count
- Comprehensive metabolic panel (including liver and kidney function)
- Lipid panel
- Urinalysis
- Screenings for STIs (gonorrhea, chlamydia, syphilis), tuberculosis, and hepatitis B and C if not previously done
Frequency of Monitoring
Current guidelines recommend monitoring viral load every 3-6 months until consistently suppressed, then every 6 months, with CD4 counts monitored less frequently once stable 1.
Additional Considerations
Assess medication adherence, side effects, and potential drug interactions. Review the patient's mental health status, substance use, and social support. Ensure appropriate vaccinations, including influenza, pneumococcal, hepatitis A/B, and HPV. Discuss sexual health, prevention strategies for partners, and reproductive planning if relevant. Regular monitoring is crucial as Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) is highly effective but requires consistent adherence to maintain viral suppression and prevent resistance development 1.
Goal of Treatment
The goal is to maintain an undetectable viral load, which prevents disease progression and eliminates the risk of sexual transmission.
From the Research
Laboratory Tests and Evaluations for HIV and AIDS Patients
According to current guidelines for persons living with HIV, the following laboratory tests and evaluations are recommended:
- CD4 cell count to assess immune function 2, 3, 4, 5, 6
- Plasma HIV-1 RNA (viral load) to monitor viral suppression 2, 3, 4, 5, 6
- Hepatitis B virus (HBV) DNA to monitor HBV coinfection 4
- Renal function tests (e.g., creatinine clearance) to monitor kidney function, especially in patients with renal impairment 6
- Liver function tests to monitor liver function, especially in patients with HBV coinfection 4
- Adherence monitoring to ensure consistent use of antiretroviral therapy (ART) 2, 5
Recommended Evaluations
- Regular clinical evaluations to monitor for signs and symptoms of HIV-related illnesses and ART side effects 2, 3, 4, 5, 6
- HLA-B*5701 testing is not required for patients starting bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) 3, 6
- Resistance testing to monitor for the development of resistance to ART, although no resistance has been reported to bictegravir/emtricitabine/tenofovir alafenamide in clinical trials 3, 4, 6