January 10, 2011

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Page 4 

Table 3. Laboratory Monitoring Schedule for Patients Prior to and After Initiation of 

 Antiretroviral Therapy (Updated January 10, 2011)

Entry 

into care

Followup before 

ART

ART 

initiation or 

modification1

2–8 weeks 

post-ART 

initiation or 

modification

Every 3–6 

months

Every 6 

months

Every 12 

months

Treatment 

failure

Clinically 

indicated

CD4 count √ every 3–6 

months

√ √ In clinically stable patients with 

suppressed viral load, CD4 

count can be monitored every 

6–12 months (see text)

√ √

Viral load √ every 3–6 

months

√ √2 √3 √ √

Resistance testing √ √4 √ √

HLA-B*5701 testing √

if considering 

ABC

Tropism testing √

if considering a 

CCR5 

antagonist

√

if 

considering 

a CCR5 

antagonist 

or for failure 

of CCR5 

antagonistbased 

regimen

√

Hepatitis B serology5 √ √

may repeat if 

HBsAg (-) and 

HBsAb (-) at 

baseline

√

Basic chemistry6 √ every 6–12 

months

√ √ √ √

ALT, AST,

T. bilirubin

√ every 6–12

months

√ √ √ √

CBC with differential √ every 3–6 

months

√ √

if on ZDV

√ √

Fasting lipid profile √ if normal, 

annually

√ √

consider 4–8

weeks after 

starting new 

ART

√

if abnormal at 

last 

measurement

√

if normal at 

last 

measurement

√

Fasting glucose √ if normal, 

annually

√ √

if abnormal at 

last 

measurement

√

if normal at 

last 

measurement

√

Urinalysis7 √ √ √

if on TDF8 √ √

Pregnancy test √

if starting EFV

√

1

ARV modification may be done for treatment failure, adverse effects, or simplification. 2

If HIV RNA is detectable at 2–8 weeks, repeat every 4–8 weeks until suppression to <200 copies/mL, then every 3–6 months. 3

For adherent patients with suppressed viral load and stable clinical and immunologic status for >2–3 years, some experts may extend the interval for HIV RNA monitoring to every 6 months. 4

For ART-naïve patients, if resistance testing was performed at entry into care, repeat testing is optional; for patients with viral suppression who are switching therapy for toxicity or 

convenience, resistance testing will not be possible and therefore is not necessary.

5 If HBsAg is positive at baseline or prior to initiation of ART, TDF + (FTC or 3TC) should be used as part of ARV regimen to treat both HBV and HIV infections. If HBsAg and HBsAb are 

negative at baseline, hepatitis B vaccine series should be administered.

6 Serum Na, K, HCO3, Cl, BUN, creatinine, glucose (preferably fasting); some experts suggest monitoring phosphorus while on TDF; determination of renal function should include estimation 

of creatinine clearance using Cockcroft-Gault equation or estimation of glomerular filtration rate based on MDRD equation. 7

For patients with renal disease, consult “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” [1]. 8 More frequent monitoring may be indicated for patients with increased risk of renal insufficiency, such as patients with diabetes, hypertension, etc.

Acronyms: 3TC = lamivudine, ABC = abacavir, ALT = alanine aminotransferase, ART = antiretroviral therapy, AST = aspartate aminotranserase, CBC = complete blood count, EFV = 

efavirenz, FTC = emtricitabine, HBsAb = hepatitis B surface antibody, HBsAg = hepatitis B surface antigen, HBV = hepatitis B virus, MDRD = modification of diet in renal disease (equation),

TDF = tenofovir, ZDV = zidovudine