Monitoring of Antiretroviral Therapy

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·         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)

 Two Men Standing Inside a Room
 References

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.

 

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