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1–30 | Clinical Manual for Management of the HIV-Infected Adult/2006
copies/mL, depending on the specific test, whereas the
older assays usually have a cut-off at 500,000 copies/mL,
whereas asymptomatic persons with chronic infection
usually have considerably lower viral loads. Viral loads,
like CD4 counts, are affected by laboratory variation,
assay fluctuations, and patient variables such as acute
illness and recent vaccinations. Variations less than
approximately 0.5 log 10 copies/mL (3-fold) usually
are not clinically significant. Viral load results that are
inconsistent with previous trends should be repeated,
and treatment decisions usually should be based on 2 or
more similar values. If patients have had recent illnesses
or vaccinations, viral load measurement should be
deferred for 4 weeks, if possible.
Viral load should be checked at least twice at baseline,
before starting an ART regimen. Follow-up viral load
measurement should be performed at regular intervals,
depending on the patient’s clinical situation (Table 3).
In the stable patient, viral load should be monitored
every 3-4 months. With new therapy or changes in
therapy, significant change in viral load or CD4 count,
or declining clinical status, the viral load should be
measured at closer intervals.
S: Subjective
A patient presents with HIV infection.
O: Objective
Complete the initial or interim physical examination
according to the protocol. (See chapters Initial
Physical Examination and Interim History and Physical
Examination.)
A: Assessment
See chapters Initial History, Initial Physical Examination,
and Initial and Interim Laboratory and Other Tests.
P: Plan
Laboratory
♦
♦
Obtain a CD4 count and perform viral load testing.
See chapter Initial and Interim Laboratory and Other
Tests for other recommended laboratory work.
Monitor the results and manage patients using
the schematic in Table 2 as a guide. See chapter
Antiretroviral Therapy for more specific information.