Clinical and laboratory monitoring
Postexposure 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 utilized 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.
In nonoccupational exposure, HIV testing should be offered at 4-6 weeks, 12 weeks, and 6 months.
Virologic and immunologic 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.
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 viremia develops or the CD4 count drops to <300 cells/microliter. 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/microliter. Monitoring the CD4 count is optional in patients with a count of >500 cells/microliter.
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