Which lab assays are used in the monitoring and management of HIV infection?

Updated: Jun 23, 2020
  • Author: Philip A Chan, MD, MS; Chief Editor: John Bartlett, MD  more...
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The key to HIV infection care and management is early treatment with antiretroviral therapy. Treatment should be started regardless of immune status or CD4 cell count. Effective HIV treatment generally involves three antiretroviral medications (see Antiretroviral Therapy for HIV Infection). Adherence to antiretrovirals is critical, as suboptimal adherence can lead to development of drug-resistant mutations. Early antiretroviral medications had tedious dosing schedules (ie, needed to be taken multiple times a day) and many had significant adverse effects. Over time, antiretroviral medications have evolved and are now significantly more effective and well tolerated. Many single-tablet regimens (multiple antiretroviral medications in a single pill) now exist. Clinicians who are less familiar with HIV infection treatment should review medication regimens carefully, as antiretrovirals come in many different combination pills and trade/generic names.

Laboratory testing in people living with HIV infection generally includes CD4 cell count (a marker of immune function) and HIV viral load assays. The HIV viral load should become undetectable during the course of treatment. Initiation of antiretroviral therapy is warranted regardless of CD4 cell count or viral load. In very rare circumstances, an individual may be infected with HIV but have an undetectable viral load without treatment. These individuals have been labeled “Elite Controllers,” and the benefit of antiretroviral treatment in these individuals is unclear. However, all other individuals with HIV infection should begin antiretrovirals as soon as possible. Rapid initiation of therapy reduces the risk of morbidity and mortality associated with HIV infection and prevents further transmission of the virus.

Adherence to therapy is ultimately key to preventing resistance. [16] HIV-specific tests are outlined below.

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