HIV


Goal = CD4 > 350

Initial Labs to order:

  1. CMP, CBC q3-6M
  2. Lipids annually, q6M if high.
  3. Fasting Glucose annually
  4. Pap q6m x 1yr, then annually if norm.
  5. CD4 count q3-6M.
  6. HIV viral load
  7. RPR or VDRL baseline
  8. Toxoplasmosis
  9. Quantiferin Gold (TB)
  10. Hepatitis panel baseline

Immunizations:

  1. Tdap
  2. Flu
  3. Pneumococcal
  4. MMR
  5. Chickenpox
  6. Hep A
  7. Hep B
  8. Guardasil

Exam to order:

  1. Dilated ophthalmology annually if CD4 < 50

Prophylaxis/Treatment:

  1. CD4< 200 - PCP pneumonia
  2. CD4 < 150 - Histoplasma capsulatum
    • Itraconazole if the patient is at risk due to occupational exposure or living in a community with a hyperendemic rate of histoplasmosis
       
  3. CD4 < 100
    • Prophylaxis against Toxoplasma gondii
       
  4. CD4 < 50 - MAC
    • Zithromax 1200mg weekly