http Module 1 Session 1 Lecture 2

1. FIRST CONSULT
Dr. Jodor Lim

2. OUTLINE
• A. Comprehensive history taking and physical
examination
• B. Laboratory Examinations
• C. Re-evaluation of Laboratories
• D. Special Considerations

3. HISTORY & P.E.
When, where and why the diagnosis was made
HIV related conditions (opportunistic
infections)
HIV medications, Immunization history
Psychiatric history, co-morbidities, STDs
Ophthalmologic dilation examination for
patients with CD4 <50
Genital and anal examination to screen for
warts

4. HISTORY & P.E.
• SOCIAL HISTORY
• Sexual identity, practices and exposure sites,
IVDU
• Marital status, partner’s HIV status
• Travel and employment history

5. LAB EXAMS
– HIV serology,Viral load, HIV genotyping, CD4
count, HLA-B*58701 (for Abacavir)
– CBC, G6PD, Lipid Profile, Urinalysis, Electrolytes,
BUN,Crea,ALT, AST, AlkPhos, TBili, TProt, Alb, FBS
or HbA1c, CXR, Sputum AFB x 3
– PPD or IGRA, Viral Hepatitis A,B and C
Screen(HBsAg), anti-CMVIgG, anti-Toxoplasma IgG,
anti-varicella IgG
– RPR, VDRL , Screen for Chlamydia and
Gonorrhea(every 3 months if positive)

6. LAB EXAMS
Other Circumstances:
• For Women: Pap smear (every 6 months, yearly if
normal), Biopsy if with ASC-US and ASC-
H,Trichomoniasis screening, anal Pap tests, annual
mammography if >50yo (individualized risk assessment
if 40-49yo), Pregnancy Test
• For Men: Testosterone levels, anal Pap tests if
applicable, abdominal UTZ (65-75 non-smoker to check
for AAA)

7. LAB EXAMS
Other Circumstances:
• Patients > 50yo: DXA screening, Colorectal exam
• CD4 <50: Cryptococcal antigen screening,
Ophthalmologic exam every 6-12 mos
• CD4 > 200 (in advanced HIV cases on ART): repeat PPD
or IGRA
• CD4 < 350 with Syphillis: do LP

8. RE-EVALUATION OF LABS
– Viral Load: once a year
– CD4: every 6 months
– STD screening: periodically, if symptomatic, if with
exposure
– FBS or HbA1c 1-3 mos after ARV initiation. If with
diabetes, monitor FBS or HbA1c every 6 months
– Lipid profile 1-3 mos after ARV initiation

9. SPECIAL CONSIDERATIONS
Mother-to-Child transmission
• Treat for HIV infection regardless of virologic status
• ART prophylaxis for exposed infants, HIV testing at 14-
21 days of life then 1-2 mos and 4-5 mos of age
• Virologic testing at birth for high risk infant

10. SPECIAL CONSIDERATIONS
Children
• HIV testing and treatment regardless of CD4 counts for
HIV-infected infants during 1st year of life
• After 1st year of life, treatment will depend on CD4
counts, symptoms, age and monitor CD4 every 3-4
months