From the Guidelines
For a 22-year-old male with HIV/AIDS on Biktarvy and Bactrim returning for a 3-month follow-up, a comprehensive panel including CD4 count, HIV viral load, complete blood count, comprehensive metabolic panel, lipid panel, and urinalysis should be ordered, along with screenings for STIs, tuberculosis, and hepatitis B/C status if not previously documented. The patient's current regimen of Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) is an appropriate single-tablet regimen for HIV management, as recommended by the 2020 guidelines from the International Antiviral Society-USA panel 1. Bactrim (trimethoprim-sulfamethoxazole) prophylaxis should continue until CD4 counts remain consistently above 200 cells/mm³ for at least 3-6 months, as per general guidelines for HIV management 1. Regular follow-up visits should occur every 3-6 months with viral load monitoring to ensure continued viral suppression, with the possibility of extending some lab monitoring to every 6 months once the patient is stable. Additionally, vaccinations as needed (influenza, pneumococcal, hepatitis A/B), screening for mental health issues, and addressing substance use if present should be considered. Discussing sexual health, prevention strategies for partners, and the importance of maintaining undetectable viral loads to prevent transmission (U=U: undetectable equals untransmittable) is also crucial. This comprehensive approach addresses both the medical management of HIV and the patient's overall wellbeing, prioritizing morbidity, mortality, and quality of life outcomes. Key laboratory tests and evaluations should be guided by the most recent and highest quality evidence, such as the recommendations from the HIV Medicine Association of the Infectious Diseases Society of America 1 and the International Antiviral Society-USA panel 1. The patient's medication adherence, side effects, and any new symptoms or opportunistic infections should also be assessed during the follow-up visit. Overall, the management of this patient should be tailored to his specific needs, with a focus on maintaining viral suppression, preventing opportunistic infections, and promoting overall health and wellbeing. The use of Biktarvy as part of the patient's antiretroviral therapy is supported by the 2018 recommendations of the International Antiviral Society-USA panel, which lists bictegravir/TAF/emtricitabine as a generally recommended initial regimen 1. By following these guidelines and recommendations, the patient's care can be optimized to achieve the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Laboratory Tests and Evaluations for HIV and AIDS Patients
The following laboratory tests and evaluations are recommended for a 22-year-old male with a recent diagnosis of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS), currently on Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) and Bactrim (trimethoprim/sulfamethoxazole), presenting for a 3-month follow-up:
- HIV-1 RNA levels to assess viral suppression 2, 3, 4, 5, 6
- CD4 count to evaluate immune system function 2, 3, 4, 5, 6
- Complete blood count (CBC) to monitor for potential side effects of antiretroviral therapy 4, 5, 6
- Liver function tests (LFTs) to assess liver health 2, 3, 4, 5, 6
- Renal function tests to evaluate kidney function 2, 3, 4, 5, 6
- Fasting lipid profile to monitor for changes in cholesterol and triglyceride levels 3, 5, 6
- Bone mineral density (BMD) test to assess bone health 3
Additional Evaluations
- Adherence to antiretroviral therapy and potential side effects 2, 3, 4, 5, 6
- Presence of opportunistic infections or other comorbidities 2, 3, 4, 5, 6
- Mental health and social support assessment 2, 3, 4, 5, 6