Approach to newly diagnosed HIV positive Pt

(CID 2020;73:e3572)

• Counsel re: excellent prognosis w/adherence to treatment, treatment options, & disclosure
• Lab evaluation: CD4 count, HIV VL & genotype, CBC w/ diff., BMP, LFTs, HbA1c, lipids, UA, PPD/ IGRA, syphilis Ab, Chlamydia & gonorrhea (3 site), Hep A/B/C, G6PD (if high-risk ethnicity), preg screen, HLA-B*5701 if Rx w/ abacavir. If AIDS: CMV IgG, Toxo IgG.
• Confirm all vaccinations (including annual flu) are up to date, avoid live vax if CD4 ≤200
• Initiate ARV early (same day, preferably after labs/genotype and w/ guidance from HIV specialist) regardless of CD4 level because ↓ mortality (NEJM 2015;373:795)
• Treatment prevents transmission to partners. Risk of transmission w/ unprotected sex w/ undetectable VL >6 months is ~0% (JAMA 2016;316:171; Lancet HIV 2018;5:e438).
• Regimens include: 2 NRTI (eg, TAF + FTC) + either INSTI or boosted PI (eg, DRV/r)