Understanding Labs

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Understanding Labs

• Elizabeth Harkey, RN
• University of Florida Jacksonville
• Rainbow Center

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Disclosure of Financial RelationshipsThis
speaker has the following significant financial
relationships with commercial entities to
disclose

• Speakers Bureau - Gilead

This slide set has been peer-reviewed to ensure
that there are no conflicts of interest
represented in the presentation.
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Objectives

• This session will address the Standards of Care
  for
• Newly HIV diagnosed patients
• Experienced HIV infected patients.
• Specific Laboratory/Diagnostic tests that might
  be needed due to HIV treatment
• Virologic and Immunologic interpretations

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Guidelines Exposed Pediatric

• HIV exposed children
• Labs Medication
• Birth HIV DNA PCR 1 ZDV
• 2 weeks Check ZDV dose
• 6 weeks HIV DNA PCR 2 D/C ZDV
• CBC/HH Start Septra
• 2 month Post test F/U Septra start
• 4 Month HIV DNA PCR 3 D/C Septra if DNA (-)
• 15 Month Elisa Western Blot
• 18 Month Elisa Western Blot

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Guidelines HIV Infected Ped

• HIV Infected children
• Frequency Labs Medications
• Q 3-4 months HIV RNA PCR (US) Doses checked
• CD4/ CD8
• Comprehensive chemistry
• CBC w/ Diff
• Q6- 12 months Lipids (Elevations with HAART/
  PIs)
• Amylase
• Lipase
• Q12 months PPD or TB evaluation if HX of () PPD

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Guidelines Adult/ Adolescent

• Time point Labs
• Initial HIV RNA PCR
• CD4/CD8
• Toxo IGG
• CMV IGG
• Hepatitis A total antibody
• Hepatitis B Surface Antibody ( if immune)
• Hepatitis B Surf Antigen ( with active
  infection)
• Hepatitis B Core Antibody ( with past/
  present infec)
• Hepatitis C Antibody
• RPR (for syphilis)
• Lipids (fasting if possible)
• UA
• Elisa Western Blot if not available
• Genotype

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Guidelines Adult/ Adolescent

• Time point Labs
• Q 3-4 months HIV RNA PCR (US)
• (US if Viral Load is lt 5,000)
• CD4/CD8
• Comprehensive Chemistry
• CBC with Differential

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Guidelines Adult/ Adolescent

• Time point Labs
• Q 6-12 months
• Lipids (fasting)
• PPD
• RPR (previously positive or sex active)
• (females) PAPS w/ HPV, Gonorrhea Chlamydia
• (males) Gonorrhea and Chlamydia

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Specialty Tests

• Genotype
• HIV newly diagnosed
• Before Beginning HAART
• Increase in Viral Load (HIV RNA PCR) greater than
  1 log
• 2 weeks after HAART w/o decrease Viral load
• 4-6 months of being on HAART w/o Viral load being
  lt400 or lt50
• Before discontinuing HAART

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HIV Specific Abnormals

• HIV RNA PRC gt1000 (on HAART)
• Consider changing HAART
• Genotype
• Adherence re-enforcement

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HIV Specific Abnormals

• CD4 lt200 or lt15
• Consider HAART
• PCP prophylaxis (Bactrim/Septra every M, T, W)
• Mepron, Dapsone (daily) Pentamadine (monthly)
• CD4 lt100
• Toxo prophylaxis (Bactrim, Septra, (M, T, W),
• Dapsone (daily)
• Toxo education areas to avoid (soil, cat feces)
• CD4 lt 50
• MAC prophylaxis (Zithromax weekly)
• CMV retinitis (narrowing of peripheral vision)
• Refer to ophthalmology for evaluation.

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Other Abnormals

• Hepatitis C Antibody ()
• Hepatitis C RNA PCR
• Hepatitis C Genotype
• Hepatitis B Surface antigen () w/ Hepatitis B
  RNA PCR
• Hepatitis B Core () History of Infection
• Hepatitis Be Antigen ()
• Increased risk of transmission

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Other Abnormals

• Toxoplasmosis ()
• Assess CD4 count and
• Treatment vs prophylaxis
• CMV ()
• Assess CD4 count and
• Treatment vs prophylaxis

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Other Abnormals

• Lipid profile elevations
• HAART involvement (Protease inhibitors, Sustiva,
  Zerit)
• Genetic
• Nutrition
• Hemoglobin lt9.0 (symptomatic)
• Medication side effects (ZDV, Videx)
• Chronic Disease
• Nutrition consult
• Possibly start ferensol
• Procrit

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Other Abnormals

• Absolute Neutrophil count (ANC) lt 1000
• Medication side effect (Septra, ZDV)
• Chronic Disease
• Switch to Dapsone (if not G6PD deficient)
• Switch to Mepron (if G6PD deficient)
• ANC calculation
• White blood cells x Granulocytes x 10
  Absolute Neutrophil count.
• (Granulocytes Segs Bands Neutrophils)

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Application
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Application
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References

• Florida AIDS Education Training Center
  http//www.faetc.org/guide/index.asp
• AIDS. ORG Laboratory results http//www.aids.org/F
  actsheets/120-Laboratory-Tests.html
• AIDS Info HIV Medical Practice Guidelines
  http//www.aidsinfo.nih.gov/Guidelines/Default.asp
  x?MenuItemGuidelines