Monitoring Your Health
Part of A Practical Guide to HIV Drug Treatment for People Living With HIV
Whether or not you are on treatment, you will likely be having "blood work" done regularly. Regular lab analysis of your blood can screen for many possible problems.
Your complete blood count (CBC) will probably be measured at each visit. The CBC checks all the major types of blood cells, including infection-fighting white cells, oxygen-carrying red cells and the platelets responsible for blood clotting. If any of these are present in abnormal numbers (too low or too high), this can alert you and your doctor to possible problems to keep a close eye on or investigate further.
Although CD4 and CD8 cells are especially important for people with HIV, your CBC may also include a detailed look at other kinds of immune cells, such as your total white blood cells, lymphocytes and neutrophils (see "Immune Cells").
Several different blood tests are used to track your liver health. Various types of liver damage or impaired function can affect your levels of liver enzymes. These liver enzymes include AST (aspartate aminotransferase), ALT (alanine aminotransferase), AP (alkaline phosphatase), GGT (gamma-glutamyltranspeptidase), a waste product called bilirubin, and a protein called albumin. Abnormal levels of any of these substances should alert you and your doctor that something (perhaps viral hepatitis, alcohol, recreational or prescription drugs) may be stressing or damaging your liver.
Your kidney health can be monitored by blood tests that measure your levels of urea and creatinine. Abnormally high levels could suggest that your kidneys are not functioning normally. Urine tests (urinalysis) can also check for things that should not be present in the urine, such as blood, protein, glucose (sugar) and white blood cells.
Blood sugar, or blood glucose, tests are an important part of monitoring the health of HIV-positive people. Some people on HIV treatment have high blood sugar levels, which should be carefully monitored. Abnormally high levels (called diabetes in the most severe cases) can lead to many health problems if not treated.
Blood fat, or lipid, levels are an important measure of your cardiovascular health -- the health of your heart and arteries. High levels of cholesterol, especially the "bad" cholesterol (low-density lipoprotein, or LDL) can lead to heart disease and hardening of the arteries. Antiretroviral medications can raise the levels of "bad" cholesterol and another type of fat called triglycerides. Blood tests can also measure your "good" cholesterol (high-density lipoprotein, or HDL), which is good for your heart health and helps to clear "bad" cholesterol from the bloodstream.
Many experts and advocates believe that people with HIV should get bone scans regularly, due to an increased risk of thinning of the bones (osteopenia and osteoporosis).
I decided to take my doctor's advice and get a bone scan to check for early-stage bone loss, which is common in both men and women with HIV as we age. Now I'm supplementing regularly with calcium, to protect against further bone loss.
Factors That May Affect Test Results
Many of your lab results, such as your CD4 count, can vary over the course of a day or if done at different labs, and can be affected by many other factors as well. It's best to have your tests done at the same time of day, at the same lab, and (if you're premenopausal) at the same time during the menstrual cycle. You may want to always be tested first thing in the morning, before eating or exercising. (Many labs require blood to be drawn for CD4 counts and viral load tests in the morning, anyway.) Some tests have to be done on an empty stomach -- in particular, blood sugar and lipid levels. Just make sure you follow any specific instructions for the tests you're doing.
Getting a vaccination (such as the flu shot) or fighting off an infection (such as a cold or the flu, especially if you have a fever) can temporarily raise your viral load and lower your CD4 count. In these cases, it may make sense to delay your blood tests for a couple of weeks. Anything else unusual that has gone on around the time of your blood tests -- such as drinking more alcohol, sleeping less or being more stressed than usual -- may affect your results.
In general, if any single CD4 count or viral load measurement seems out of line, a repeat test will reveal whether the difference is a new trend or just a "one-off." The overall trends in your results are more important than any single result.
Tracking Your Lab Results
Below, we've included a set of sheets you can use to keep track of your lab results, medications, symptoms and other key pieces of health information. There are also tools available online that can help you keep track of other lab results or graph them over time. Here are a couple you can try:
Monitoring your health -- online learning module covering CD4 counts, viral load and other tests used to track your health
HIV Viral Load Testing -- informative brochure on the viral load test and how it fits into your treatment plan
In-depth Fact Sheets on AIDS-related infections and cancers and HIV transmission
The Positive Side -- health and wellness magazine for people with HIV, featuring such articles as:
Look in the e-zine index for more (www.positiveside.ca).
These and many other relevant resources can be accessed on CATIE's website (www.catie.ca), through the CATIE Ordering Centre or by calling CATIE at 1-800-263-1638.
This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.
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