· Tests for Monitoring responses to Antiretroviral treatment and diagnosis of treatment failure/toxicity are important
· Clinical assessment and laboratory tests play a key role in assessing individuals before ART is initiated, monitoring treatment response and possible toxicity of ARV drugs.
· The following laboratory tests are recommended:
o HIV Viral Load test is a preferred monitoring approach to diagnose and confirm early treatment failure.
§ HVL for adults and adolescents should be done 6 months after initiation of ART
§ Successful antiretroviral therapy result in decrease of HIV viral load, immune recovery and therefore increase in number of CD4 cells.
o CD4 T lymphocytes count should also be done at baseline for all clients.
§ CD4 cells progressively decrease as HIV advances and immune status deteriorates. Measurements of CD4 cells counts are important immunological markers of the disease progression.
§ CD4 cells counts are reported in percentage (%).
§ CD4 testing will be measured as a baseline test and for suspected treatment failure for those clients on ART
o A complete blood count (If not available, conduct hemoglobin test for patients on AZT based regimens)
o Urinalysis to exclude proteinuria (HIV associated nephropathy or HIVAN) and glycosuria (Diabetes Mellitus).
o Tests to rule out active TB (sputum AFB, GeneXpert, CXR) in cases where there is suspected TB from the screening tool
o Urine pregnancy test (to women of reproductive age) in order to identify PLHIV requiring EFV 600mg.
o Liver function tests (serum alanine aminotransferase, ALT) if on anti-TB drugs or requiring NVP based treatment
o Renal function tests (serum creatinine, blood urea nitrogen (BUN)) for patients requiring TDF based regimens
o Lipids test (for clients requiring PIs)
Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6th Ed). New York, NY: McGraw-Hill.
DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7th ed): New York, NY: McGraw-Hill.
Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach: New York, NY: McGraw-Hill.
Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7th ed): New York, NY: McGraw-Hill.