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HIV and Tests/Labs

Aug 25, 2010

Besides the regular CD4, viral load, and CBC, what tests should we be getting? I'm 34. I've been checked for the Heps and I've had my cholesterol/triglycerides checked. However, I keep hearing other HIVers say they get their urine checked--saying the BUN and Creatinine may not show a true picture. I've had others say they have been checked for HPV, CMV, Toxo, and other things like that. Although I know most of us would be positive for those and with some there isn't much you can do about it. Some have gotten anal pap smears, but I know that isn't done at most places yet.

I've heard many talk about getting Vitamin D levels checked. I know many of us are deficient. Some say we should be on a supplement, but I get confused when they say we should take Vit-D3 supplements. I didn't know there were differences. And, I've read that you actually need sunlight to activate Vit D supplements.

I've been having these sharp pains that will shoot from around my stomach area up into my chest. I thought this was probably just bowel issues or anxiety. Should we have our hearts checked with more sophisticated tests? Is this what a stress test does?

I guess I'm just wondering what tests you have your patients do besides the normal CD4/viral load? I want to be proactive to find any problems early like heart problems, cancers, kidney, and liver problems. I have a family history of colon, rectal, bone, and liver cancers. I know there have been about 5 non-immediate family members with colon and rectal cancer.

Response from Dr. McGowan

Thanks for your question.

As you indicate HIV has very broad effects on many organs of the body, not just the immune system (although many of the broad effects are mediated through the immune system). In addition, medications we use to treat HIV can have effects on liver and kidney function, bone density, etc. Many effects, such as the increased risk for heart disease may be caused by both the HIV and medication.

Many tests (such as screening for toxoplasmosis, CMV, cryptococcus, etc) will only be needed whne CD4 counts are low (below 200). Other tests (such as colonoscopy or mammograms) may only be needed over a specific age. Some, such as anal PAP are done in men who have sex with men and in women with abnormal cervical Pap (these are screens for HPV - human papilloma virus- infection). Women should have a PAP smear at least annually.

It is a good idea to have a fasting blood glucose and lipids (cholesterol/triglycerides) at least once a year...both HIV and medication can effect these. We will generally screen all patients for hepatitis A, B and C and vaccinate negatives for Hep A and B. We screen annually for evidence of tuberculosis infection. We check for syphilis (and routinely for gonorrhea and chlamydia for all sexually active people) at least once a year.

We have been routinely screening for vitamin D since levels have been found to be low in many people with HIV. DEXA scans to assess bone density may be done in specific cases and in post-menopausal women. I addition, we will screen men for low testosterone if they have symptoms.

It is best to receive your treatment from an HIV expert who will be able to do all the routine testing and will be up to date on expanded screening that may be needed.

Best, Joe

PEP with Truvada for occpational exposure
Question on meds.

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