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What should the inital labwork screen for in AIDS DX
Aug 8, 2004

Hello, First I want to say thank you for all the outstanding information that is available on this web site. I am a HIV Case Manager, BSW that has worked in a HIV arena for many years recently relocated to a rual area with little HIV tx available and what is available is not very aggrssive - when I think that it should be anyway 2 questions 1) Could you provide me with a list of routine labs that is drawn in a new pt and please list the differences when the pt is obviously sick as opposed to someone that maybe newly infected or not progressing (ie: screen for OI) 2) When do you presumptivly tx Toxoplamosis, especially when they display many symtoms and you are waiting on labs for upto 5 days thanks.

Response from Dr. Young

Thank you for your question.

There are a number of lab tests that I request when I first see a patient with HIV infection. First, the HIV labs: HIV antibodies, HIV viral load, and CD4 cell count; whenever possible, I obtain a HIV drug resistance test. I look for evidence of prior infections: hepatitis (HAV, HBV, HCV) antibodies, toxoplamsa and syphillis antibodies. Last comes general labs: chemistry profile, testosterone level. In general, CD4 counts below 350 are cause for concern and should prompt a fairly expeditious clinical follow up; below 200 are serious and indicative of an AIDS diagnosis. For patients with counts below 200, we not only consider initiation of HIV therapies but antibiotics (Bactrim, Septra) to prevent opportunistic infections.

As for your second group of questions-- Toxoplasmosis is suspected in persons with central nervous system symptoms; diagnosis is made presumptively with CT scans of the brain (with or without brain biopsy) that show "ring enhancing" lesions. This is where a positive Toxoplasma antibody test (IgG) is helpful. Since treatment for these persons is relatively simple, empirical treatment can be initiated prior to a confirmation of the diagnosis.

Lastly, as a healthcare profession, I'd should direct your attention to TheBodyPro-- our website for professionals like you. Thanks for reading. BY



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