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Considerations for Patients with Established HIV
Infection
Patients with established HIV infection are discussed in two arbitrarily
defined clinical categories: 1) asymptomatic infection or 2) symptomatic
disease (wasting, thrush or unexplained fever for > 2 weeks) including
AIDS, defined according to the 1993 CDC classification system (23).
All patients in the second category should be offered antiretroviral
therapy. Considerations for initiating antiretroviral therapy in
the first category of patients are complex and are discussed separately
below. Before initiating therapy in any patient, however, the following
evaluation should be performed:
- Complete history and physical (AII)
- Complete blood count, chemistry profile (including serum transaminases
and lipid profile) (AII)
- CD4+ T lymphocyte count (AI)
- Plasma HIV RNA Measurement (AI)
Additional
evaluation should include routine tests pertinent to the prevention
of OIs, if not already performed (VDRL, tuberculin skin test, toxoplasma
IgG serology, and gynecologic exam with Pap smear), and other tests
as clinically indicated (e.g., chest X-ray, hepatitis C virus (HCV)
serology, ophthalmologic exam) (AII). Hepatitis B virus (HBV) serology
is indicated in a patient who is a candidate for the hepatitis B
vaccine or has abnormal liver function tests (AII), and CMV serology
may be useful in certain individuals, as discussed in the "USPHS/IDSA
Guidelines for the Prevention of Opportunistic Infections in Persons
Infected with the Human Immunodeficiency Virus" (2) (BIII).
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