HIV in adults

Monitoring is recommended after initiation or modification of antiretroviral therapy (ART) to assess the virological and immunological efficacy of ART and to monitor for laboratory abnormalities that may be associated with antiretroviral drugs. The following laboratory testing is recommended after initiation of ART.[82]US Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Sep 2025 [internet publication]. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new

• CD4 count: at 3 months after ART initiation, and then every 3-4 months (if CD4 count <300 cells/microlitre) or 6 months (if viral suppression and CD4 count is ≥300 cells/microlitre) during the first 1-2 years. After 1-2 years on ART with consistently suppressed viral load and CD4 count ≥300 cells/microlitre, monitoring is optional unless clinically indicated. Also recommended if treatment failure (every 3-6 months), clinically indicated, or every 3-6 months if ART is deferred.

• HIV viral load: 4-8 weeks after ART initiation/modification. If HIV RNA is detectable at 4-8 weeks, repeat testing every 4-8 weeks until viral load is suppressed to <50 copies/mL. Thereafter, repeat testing every 3-6 months (every 3 months during the first 2 years of ART, then can extend to every 6 months for patients with consistent viral suppression ≥2 years). More frequent monitoring may be considered in individuals who are having difficulties with ART adherence. Also recommended if treatment failure, clinically indicated, or every 3-6 months if ART is deferred.

• Resistance testing (reverse transcriptase and protease genes): only recommended if treatment failure or clinically indicated. If ART is deferred, repeat testing is optional and may be considered at the time of initiation.

• Resistance testing (integrase genes): only recommended if treatment failure or clinically indicated (if there is a history of integrase strand transfer inhibitor use). If ART is deferred, repeat testing is optional and may be considered at the time of initiation.

• Tropism testing: only recommended if treatment failure (if considering a CCR5 antagonist or patients with virological failure on a CCR5 antagonist) or clinically indicated.

• Hepatitis B screening: if clinically indicated only (e.g., before starting direct-acting antivirals for hepatitis C virus infection).

• Hepatitis C screening: every 12 months (in at-risk people) or if clinically indicated.

• Basic metabolic panel: 4-8 weeks after ART initiation/modification (in people with pre-existing conditions or at risk of laboratory changes after ART initiation), and then every 6-12 months. Also recommended if clinically indicated, or every 6-12 months (or if clinically indicated) if ART is deferred.

• Liver function tests: 4-8 weeks after ART initiation/modification (in people with pre-existing conditions or at risk of laboratory changes after ART initiation), and then every 6-12 months. Also recommended if clinically indicated, or every 6-12 months (or if clinically indicated) if ART is deferred.

• Full blood count with differential: every 3-6 months initially (when monitoring CD4 count), and then every 12 months (when no longer monitoring CD4 count). Also recommended if clinically indicated, or when monitoring CD4 count (or if clinically indicated) if ART is deferred.

• Lipid profile: 3-6 months after ART initiation or modification (once viral suppression achieved), and then every 12 months (if aged ≥40 years or on statin therapy) or every 1-3 years (if aged <40 years and not on statin therapy). Also recommended if clinically indicated (if there are changes in cardiovascular risk factors).

• Random or fasting glucose level: if clinically indicated or treatment failure.

• Urinalysis: if clinically indicated only (e.g., patients with diabetes mellitus or chronic kidney disease).

• Pregnancy test: if clinically indicated only.

Adherence to ART should be regularly assessed at every clinic visit.