Monitoring

Clinical and laboratory monitoring

Post-exposure monitoring in HIV-negative individuals:

  • In occupational exposure, HIV testing should be offered at baseline, 6 weeks, 12 weeks, and 6 months.

  • If a newer, fourth-generation, combination HIV p24 antigen-HIV antibody test is utilised for follow-up HIV testing of exposed individuals, HIV testing may be concluded 4 months after exposure.

  • If a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after HIV exposure.[137]

  • In non-occupational exposure, HIV testing should be offered at 4-6 weeks, 12 weeks, and 6 months.[138]

Virological and immunological monitoring:

  • A patient with early HIV disease should be monitored every 3-6 months, whereas a patient with late HIV disease should be monitored every 2-3 months.

  • At each visit patients should be assessed for opportunistic infection and their clinical stage updated.

  • HIV RNA (viral load) should be measured at entry into care and immediately prior to commencing antiretroviral therapy (ART). While on ART, HIV RNA should be checked at 2-8 weeks after commencing therapy, every 3-4 months during the first 2 years of therapy, and every 6 months after 2 years of therapy with consistently suppressed viral load.[139]

  • A CD4 count should be done at entry into care and prior to initiation of ART. While on ART, the CD4 count should be checked 3 months after the initiation of therapy, then every 3-6 months for the first 2 years of therapy or if viraemia develops or the CD4 count drops to <300 cells/microlitre. After 2 years, patients with a consistently suppressed HIV RNA (viral load) can have their CD4 count checked every 12 months if their CD4 count is 300-500 cells/microlitre. Monitoring the CD4 count is optional in patients with a count of >500 cells/microlitre.[139]

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