Initial visit

• Complete medical history
  
• Physical examination, including height, weight, BMI, blood pressure, waist circumference
  
• Laboratory evaluation
  • Confirmation of HIV antibody positive
    
  • Plasma HIV RNA
    
  • Resistance testing (genotype) with determination of HIV subtype
    
  • CD4 absolute count + percentage (optional: CD8 and %)
    
  • Complete blood count, AST, ALT, Alk phosphatase, calcium, phosphate, glucose, creatinine, calculated creatinine clearance
    
  • Antibody tests for toxoplasma, CMV, Hepatitis A, B and C and syphilis
    
  • Fasting blood glucose and lipids including fasting total LDL & HDL cholesterol, and triglycerides (see metabolic guidelines)
    
  • Urine dipstick for protein and sugar
    
  • HLA B*5701 determination (if available)
    
  • R5 tropism (if available)
    
  • Cardiovascular risk assessment
• Sexually Transmitted Infection screen if appropriate
  
• Women: cervical pap smear
  
• Assessment of social and psychological condition: provide support and counselling if needed
  
• Consider HAV and HBV vaccination (depending on serology results) and pneumococcal vaccination
  
• PPD if CD4 above 400. Negative PPD does not exclude active or latent tuberculosis. T.SPOT.TB® (or QuantiFERON-TB Gold IT®) can be an alternative to PPD in selected high risk populations (if available)

Subsequent visits (Asymptomatic patients not receiving antiretroviral therapy)

• At least every 6 months
  
  • Complete blood count, CD4 count and %
    
  • Plasma HIV RNA
    
• Every year
  • Physical examination
    
  • Evaluation of social and psychological support,
    
  • Smoking cessation, diet evaluation
    
  • Repeat serologic testing (syphilis, CMV, toxoplasmosis, hepatitis B, hepatitis C) if previously negative
    
  • AST, ALT
    
  • Women: cervical pap smear
    
  • Fasting lipids
    
• Every 6 months
  
  • If cirrhosis (regardless of cause): alphafoetoprotein + ultrasound examination
• Treatment initiation
  
  • Assess and support patients’ readiness to start combined ART (see specific Table)
    
  • Physical examination, including height, weight, BMI, blood pressure, waist circumference
    
  • Plasma HIV RNA
    
  • Resistance testing (genotype), if not yet obtained
    
  • CD4 count and % (optional: CD8 count and %)
    
  • Complete blood count, AST, ALT, bilirubin, creatinine, calculated creatinine clearance, calcium, phosphate
    
  • Fasting glucose and lipids
    
  • Urine dipstick for protein and sugar
    
  • Other laboratory parameters may be useful according to selected first-line regimen e.g. protein creatinine ratio, amylase, lipase
    
  • Cardiovascular risk assessment
• Visits on therapy
  
  • Plasma HIV RNA
    
  • CD4 count and % (optional: CD8 count and %)
    
  • Complete blood count, creatinine, calculated creatinine clearance, AST, ALT bilirubin
    
  • Other laboratory parameters according to selected regimen
    
  • Fasting glucose and lipids