HIV And Hepatitis Suggested Tests for Consideration

Please ensure that all patients have the following pasted into the HIV bloods/STI monitoring section of plan:

1) Basic 4-6 monthly2) Basic annual

Then add in any other necessary tests under the 4-6 monthly or annual headers

The following tests are high cost! Always consider if they are necessary:HIV Viral Load, HIV Incidence, HIV Resistance (ask for integrase resistance ONLY if required), HIV-1 Tropism, Lymphocytes Subsets, HLA test (ONLY if ABC considered)

Consider need for G6PD testing

Basic HIV 4-6 monthlyOFF ARTPLEASE CHECK 4-6 MONTHLY:CreatinineLiver ProfileUrinalysisFull blood countLymphocyte subsets*syphilis antibody/RPR (DELETE ONE/BOTH AS APPROPRIATE)Always consider syphilis and STI screening especially in MSM + hepatitis C risk

ON ARTPLEASE CHECK 4-6 MONTHLY:CreatinineHIV viral loadLiver ProfileBone profile (DELETE IF NOT ON TENOFOVIR)UrinalysisLymphocyte subsets (ONLY IF INDICATED)*syphilis antibody/RPR (DELETE ONE/BOTH AS APPROPRIATE)Always consider syphilis and STI screening especially in MSM + hepatitis C risk

Basic annual monitoringPLEASE CHECK THE FOLLOWING ONCE A YEAR <ADD APPROX MONTH DUE>Renal/liver/bone profileFull blood countLymphocyte subsets (PLEASE DELETE IF CD4 >350/500 ON ART AND PT HAPPY TO OPT OUT)HIV viral loadLipid profileGlucoseUrinalysisHepatitis C screen (if at risk – DELETE IF NOT)*syphilis antibody/RPR (DELETE ONE/BOTH AS APPROPRIATE)Always consider syphilis and STI screening especially in MSM + hepatitis C riskConsider need for hepatitis B screeningHepatitis B monitoring (add appropriate line to annual list)Natural immunity (core Ab+ surface Ab +) annual surface antibodyPrior infection (core Ab+ surface Ab-) annual surface antigenVaccinated immunity (core Ab-, sAb >100) surface antibody every 2 years <APPROX DATE DUE>Vaccinated immunity (Core Ab-, sAb <100) surface antibody annuallyIF sAB <10 AT ANY TIME AND RISK OF HBV CHECK SURFACE ANTIGEN

Text for blood tests on CELLMA 18_12_2014 Laura Waters & Simon EdwardsReview date December 2015

Add to 4-6 monthly if HBV/HCV coinfected Add to annual if HBV/HCV coinfectedFull blood countAspartate transaminaseAlphafetoprotein (DELETE IF NO FIBROSIS)Hepatitis B DNA (only if HBV + on ART)

Aspartate transaminaseAlphafetoproteinGamma GTCoagulation profileHepatitis B DNA (only if HBV + on ART)Hepatitis D screen (HBV coinfected only!)

When to send hepatitis C viral load – patients with known hepatitis C, not on treatment DO NOT NEED THIS CHECKED!!!!

To confirm a diagnosis (may include retrospective testing)To confirm if acute infection clearing or notDuring & after HCV treatmentTo screen for HCV if abnormal LFT + risk or if prior infection (lifelong HCV Ab+)Hepatitis C genotype – only at diagnosis or ?reinfection

New diagnosis/transfer HIV New hepatitis patientFull Blood CountHepatitis A and BHepatitis C antibodySyphilis antibody/RPR <DELETE ONE>HIV Viral LoadHIV AntibodiesHIV Incidence TestHIV ResistanceLymphocytes SubsetsRenal Liver and BoneToxoplasma AntibodiesUrine ProteinLipid ProfileIGRA (only if indicated see below)*delete if has up to date HAV/HBV resultsTRANSFER: No resistance test or incidence test needed – otherwise as for new diagnosis

Alpha-FetoproteinAuto-Antibody ScreenRenal/Liver ProfileCaeruloplasminFerritinFull Blood CountGlucoseLipid ProfileCoagulation ScreenAspartate TransaminaseGamma-Glutamyl TransferaseImmunoglobulins (G,A,M)GlucoseHepatitis A Igg Antibody, HBV/HCV as neededAlpha 1 antitrypsinAll may not be necessary if checked before or recently

When to send an IGRA test1. Sub-Saharan Africa, if ART <2 years, whatever the current blood CD4 cell count2. Medium TB incidence* countries, if on ART <2 years and current CD4 <5003. Low-incidence countries if not on ART or on ART <6 months and current CD4 <350

* includes Eastern Europe, Central Asia, North Africa, Middle East, South Asia, East Asia, CaribbeanTropical eosinophilia screen Renal test to consider (some high cost!)

Schistosoma Elisa SerumOva Cysts & Parasites (stool)Strongyloides CultureStrongyloides SerolFiltration of Urine (Africa only)Filaria Elisa Serum (Africa only)

25-Hydroxy Vitamin DUrine ProteinU.Retinol Binding ProteinFractionated PO4 ReabsorptionUrine AlbuminParathyroid hormone

Bloomsbury Diarrhoea set (some = high cost, only select those indicated! Remember STIs)

Bloomsbury respiratory tests to consider

Text for blood tests on CELLMA 18_12_2014 Laura Waters & Simon EdwardsReview date December 2015

Blood CultureC. Difficile TestOva Cysts & ParasitesFaeces CultureFaecal elastase

AFB Culture (sputum)Blood CultureSputum Culture (bacterial)C-Reactive ProteinViral throat swab

Hepatitis B monoinfection – frequency will depend on stage of HBV and fibrosis

Hepatitis C monoinfection

Hepatitis B Viral LoadHBV Supplementary SerologyHepatitis D screenAlpha-FetoproteinFull Blood CountBlood Renal/Liver ProfileAspartate TransaminaseHepatitis B surface antigen/antibodyCoagulation <acute HBV or liver disease>REMEMBER REGULAR USS IF INDICATED

Alpha-Fetoprotein (6-12 monthly if fibrosis)Full Blood CountAspartate TransaminaseBlood Renal/Liver ProfileHepatitis C genotype only at diagnosisHepatitis C viral load only at diagnosis and during/after treatmentCoagulation <if indicated>REMEMBER REGULAR USS IF FIBROSIS

Hepatitis C treatment monitoring Tests to consider if abnormal LFTFull Blood CountG-Glutamyl TransferaseHepatitis C Viral Load*Coagulation Screen*Renal Liver and BoneAspartate TransaminaseThyroid Profile*Urate*Glucose*not required at all visits

SyphilisCoagulation profileGamma GTAspartate transaminaseFull blood countRenal profileVitamin D/protein electrophoresis/urinary BJP if raised ALP and normal GGTHepatitis C RNA/antigenHepatitis A IgMHepatitis B surface antigen +/- DNA*Hepatitis E screen**only after discussion with hepatitis teamAlways consider EtOH and drugs

Text for blood tests on CELLMA 18_12_2014 Laura Waters & Simon EdwardsReview date December 2015