British HIV Association guidelines for the routine investigation and monitoring of adult HIV‐1‐infected individuals 2011
Authors: Asboe D , Aitken C , Boffito M , Booth C , Cane P , Fakoya A , Geretti AM , Kelleher P , Mackie N , Muir D , Murphy G , Orkin C , Post F , Rooney G , Sabin C , Sherr L , Smit E , Tong W , Ustianowski A , Valappil M , Walsh J , Williams M , Yirrell D ,   BHIVA Guidelines Subcommittee
Published: December 2011

Table of Contents

1. Levels of evidence

1.1 Reference

2. Introduction

3. Auditable targets

4. Table summaries

4.1 Initial diagnosis

4.2 Assessment of ART‐naïve individuals

4.3 ART initiation

4.4 Initial assessment following commencement of ART

4.5 Routine monitoring on ART

4.6 References

5. Newly diagnosed and transferring HIV‐positive individuals

5.1 Initial HIV‐1 diagnosis

5.2 Tests to determine whether acquisition of HIV infection is recent

5.3 Individuals transferring care from a different HIV healthcare setting

5.4 Communication with general practitioners and shared care

5.5 Recommendations

5.6 References

6. Patient history

6.1 Initial HIV‐1 diagnosis

6.2 Monitoring of ART‐naïve patients

6.3 Pre‐ART initiation assessment

6.4 Monitoring individuals established on ART

6.5 Assessment of adherence

6.6 Recommendations

6.7 References

7. Examination

7.1 Recommendations

8. Identifying the need for psychological support

8.1 References

9. Assessment of immune status

9.1 CD4 T cell counts

9.2 CD4 T cell percentage

9.3 References

10. HIV viral load

10.1 Initial diagnosis/ART naïve

10.2 Post ART initiation

10.3 Individuals established on ART

10.4 Recommendations

10.5 References

11. Technical aspects of viral load testing

11.1 References

12. Viral load kinetics during ART and viral load ‘blips’

12.1 References

13. Proviral DNA load

13.1 References

14. Resistance testing

14.1 Initial HIV‐1 diagnosis

14.2 ART‐naïve

14.3 Post treatment initiation

14.4 ART‐experienced

14.5 References

15. Subtype determination

15.1 Disease progression

15.2 Transmission

15.3 Performance of molecular diagnostic assays

15.4 Response to therapy

15.5 Development of drug resistance

15.6 References

16. Other tests to guide use of specific antiretroviral agents

16.1 Tropism testing

16.2 HLA B*5701 testing

16.3 References

17. Therapeutic drug monitoring

17.1 Recommendations

17.2 References

18. Biochemistry testing

18.1 Introduction

18.2 Liver function

18.3 Renal function

18.4 Dyslipidaemia in HIV‐infected individuals

18.5 Other biomarkers

18.6 Bone disease in HIV‐infected patients

18.7 References

19. Haematology

19.1 Haematological assessment and monitoring

19.2 Recommendations

19.3 References

20. Serology

20.1 Overview

20.2 Hepatitis viruses

20.3 Herpes viruses

20.4 Measles and rubella

20.5 Cytomegalovirus (CMV)

20.6 References

21. Other microbiological screening

21.1 Tuberculosis screening

21.2 Toxoplasma serology

21.3 Tropical screening

21.4 References

22. Sexual health screening including anal and cervical cytology

22.1 Sexual history taking, counselling and sexually transmitted infection (STI) screening

22.2 Cervical and anal cytology

22.3 Recommendations

22.4 References

23. Routine monitoring recommended for specific patient groups

23.1 Women

23.2 Older age

23.3 Injecting drug users

23.4 Individuals coinfected with HBV and HCV

23.5 Late presenters

23.6 References

Appendix