- Section 2: Testing and Assessment
- Initial History
- Initial Physical Examination
- Initial and Interim Laboratory and Other Tests
- Interim History and Physical Examination
- HIV Classification: CDC and WHO Staging Systems
- CD4 and Viral Load Monitoring
- Risk of HIV Progression/Indications for ART
- Early HIV Infection
- Expedited HIV Testing
- Resistance Testing
- Karnofsky Performance Scale
- Occupational Postexposure Prophylaxis
- Nonoccupational Postexposure Prophylaxis
- Preventing HIV Transmission/Prevention with Positives
- Immunizations for HIV-Infected Adults and Adolescents
- Preventing Exposure to Opportunistic and Other Infections
- Opportunistic Infection Prophylaxis
- Latent Tuberculosis Infection
- Smoking Cessation
- Abnormalities of Body-Fat Distribution
- Insulin Resistance, Hyperglycemia, and Diabetes on Antiretroviral Therapy
- Coronary Heart Disease Risk
- Renal Disease
- Immune Reconstitution Inflammatory Syndrome
- Anal Dysplasia
- Candidiasis, Oral and Esophageal
- Candidiasis, Vulvovaginal
- Cervical Dysplasia
- Cryptococcal Disease
- Cytomegalovirus Disease
- Gonorrhea and Chlamydia
- Hepatitis B Infection
- Hepatitis C Infection
- Herpes Simplex, Mucocutaneous
- Herpes Zoster/Shingles
- Kaposi Sarcoma
- Molluscum Contagiosum
- Mycobacterium avium Complex Disease
- Mycobacterium tuberculosis
- Pelvic Inflammatory Disease
- Pneumocystis Pneumonia
- Progressive Multifocal Leukoencephalopathy
- Seborrheic Dermatitis
Initial Physical Examination
Publish date: April 2014
Many of the conditions that put immunocompromised patients at risk of disease can be detected early, by means of a thorough history and physical evaluation.
See chapter Initial History.
Assess the patient's general appearance, affect and demeanor in answering questions, body language, and other relevant characteristics. Measure vital signs; perform a physical examination. These measurements establish a baseline against which future measurements can be compared.
Table 1. Vital Signs
|Height||Should be measured at baseline and annually.|
|Weight||Record at each visit.|
|Temperature||Record at each visit.|
|Blood pressure||Record at each visit. The BP cuff size should be appropriate for the patient's arm circumference.|
|Heart rate||Record at each visit.|
|Respiratory rate||Record at each visit.|
|Oxygen saturation||Record at each visit.|
|Waist, hip circumferences||Waist and hip circumference should be measured at baseline for comparison in case the patient later develops obesity or lipoaccumulation related to antiretroviral therapy (ART); repeat as indicated.|
|Body mass index (BMI)||BMI can be helpful in assessing underweight or overweight conditions, HIV/AIDS-related weight loss, and ART-related weight gain. Perform at baseline and upon changes in weight.|
|* Anal Pap test: Consider this test if follow-up evaluation of an abnormal Pap test result is available. Rates of anal dysplasia and anal cancer are higher in HIV-infected women and men than in HIV-uninfected individuals; see chapter Anal Dysplasia.|
|Genitals / Rectum|
|Extremities / Musculoskeletal|
|Neurologic||Assess the following:|
A/P: Assessment and Plan
After completing the initial history and physical examination, do the following:
- Enter the information garnered through the history and physical examination into the patient's chart or database.
- Continue to develop the problem list, assessment, and plan for patient care.
- Complete follow-up or laboratory studies suggested by the history and physical examination. (See chapter Initial and Interim Laboratory and Other Tests.)
- Prescribe opportunistic infection prophylaxis as appropriate. (See chapter Opportunistic Infection Prophylaxis.)
- Arrange for any appropriate vaccinations. (See chapter Immunizations for HIV-Infected Adults and Adolescents.)
- Refer for dental, nutrition, and social services, as well as case management and mental health care, as appropriate.
- Refer for any additional specialty care needs identified in the history or physical examination.
- Make follow-up appointment with health care provider.
- Answer the patient's questions.
- Aberg JA, Gallant JE, Ghanem KG et al.; HIV Medicine Association of the Infectious Diseases Society of America. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jan;58(1):e1-e34.
- Hollander H. Initiating Routine Care for the HIV-Infected Adult. In: Sande MA, Volberding PA, eds. The Medical Management of AIDS, 5th Edition. Philadelphia: WB Saunders; 1997:107-112.
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Accessed December 1, 2013.
- Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Accessed December 1, 2013.
Search the Clinical Guide
Abbreviations for Dosing Terminology
- twice daily
- twice weekly
- intramuscular (injection), intramuscularly
- intravenous (injection), intravenously
- oral, orally
- Q2H, Q4H, etc.
- every 2 hours, every 4 hours, etc.
- every morning
- once daily
- every hour
- every night at bedtime
- four times daily
- every other day
- every evening
- three times daily
- three times weekly