BASELINE EVALUATION
A standard clinical and laboratory evaluation is recommended prior to initiation of ART. It is intended to establish the baseline status for future comparison, individualizing ART according to patient’s clinical status and preferences, and ruling out active OIs.
History
Points to be elicited in history taking:
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HIV specific symptoms- present and past
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Genital ulcers and other sexually transmitted diseases
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Personal history-
smoking, alcohol, Drugs
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Past history of any
coronary artery disease
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High risk behavior- partner’s
HIV sero-status if known
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Women- gynecological history, past
pregnancies,contraception
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Family history of
coronary disease,
hypertension,
diabetes and hyperlipidemia
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Treatment history: any past or current use of ARVs (useful for designing ART regimen), sexual partners ARV use, ARV use during
pregnancy and use of any alternative (e.g.herbal) preparations.
Physical examination
A routine physical examination is essential prior to initiating ART. Following evaluation is recommended:
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Body weight, height,
Body Mass Index
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Temperature/Lymph-node
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Dermatological/Oral cavity: oral
candidiasis, oral hairy leukoplakia
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Genital/Pelvic (women)
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Systemic examination
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Fundus examination
Laboratory evaluation
The purpose of baseline laboratory evaluation is to stage
HIV disease, rule out concomitant infections and determine baseline safety parameters. The following tests are recommended:
Essential
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Confirm HIV infection : A pre-requisite prior to ART initiation, it also is needed to rule out HIV-2 infection.Non-nucleoside reverse transcriptase inhibitor’s (NNRTIs) haveno activity against HIV-2.20
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2. Specific investigations to rule out OIs
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3. CD4 counts : Estimated by flow-cytometry. Alternative low cost technologies are becoming available, however further evidence is needed to recommend its routine use in clinicalpractice.21
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CBC : Baseline Hemoglobin and WBC counts are needed to monitor hematological toxicity on Zidovudine (ZDV).
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LFTs : Necessary to find evidence of
hepatitis, particularly when NVP use is contemplated.
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Urine routine: To evaluate proteinuria and sugar (necessitate estimation of blood glucose)
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Creatinine : Dose of some nucleoside reverse transcriptase Inhibitors (NRTIs) has to be adjusted according to creatinine clearance.
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HBsAg : To rule out concomitant
hepatitis B infection, this can influence choice of ARV regimen. Additionally, abrupt stopping of anti-HBV Drugs like lamivudine and tenofovir is not recommended in patients with chronic
hepatitis B co- infection since it may result in hepatitis B flare.22
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Chest X-ray : To rule out TB or other
pulmonary infection
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VDRL/TPHA
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Pap smear : Helps in earlier diagnosis of cervical intraepithelial neoplasia (CIN)