WELLNESS STARTS WITH AWARENESS - CD8 T cells - The Body

Maintaining wellness (or as we old-timers used to say, “staying
healthy”) involves a collaboration between you and
your health care provider. Th e process is far too complex
to be reduced to a simple checklist, but there are some objective
things you can do to help optimize your health, including regular
lab testing and vaccinations. It’s a good idea to keep your own
record of the most important test results, vaccination dates, and
your antiretroviral therapy (ART) history, especially if you’re ever
likely to move or change doctors.
Routine Tests
CD4 count: Measures the health of your immune system and
your risk for opportunistic infections (OIs). Higher numbers are
better. Th e most important test for deciding whether to st art antiretroviral
therapy (ART) and OI prophylaxis (preventive therapy).
Ordered at baseline and repeated every 3-6 months.
Viral load: Measures viral replication (the activity of the virus).
Lower numbers are better. People with high viral loads tend to progress
more rapidly than people with low viral loads. Th e most important
measure of whether your drugs are working: it should become
undetect able on treatment. Ordered at baseline and repeated every
3-4 months.
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Wellness
Checklist
Important things to consider
when you’re HIV-positive
by Joel Gallant, MD, MPH
Resistance test: Determines whether your virus is resistant to
antiretrovirals (ARVs). Should be ordered at baseline and whenever
your treatment is failing with a viral load of over 500-1,000. Th ere
are two types of resistance tests. Genotypes look for mutations that
cause drug resistance. Th ey’re cheaper, faster, and fi ne for most purposes.
Phenotypes measure how well the virus grows in the presence
of varying concentrations of ARVs. Th ey have advantages in people
with a lot of resistance, especially to protease inhibitors (PIs). Th e
combined test (PhenoSense GT) measures both. Th e virtual phenotype
(VircoTYPE) uses a genotype to estimate the phenotype.
Complete Blood Count (CBC): Measures your white blood
cell count, red blood cell count, platelet count, hemoglobin, and
hematocrit. A low hemoglobin and hematocrit mean you’re anemic.
Ordered at baseline and every 3-6 months (usually whenever you
get a CD4 count). Should be checked more frequently aft er starting
AZT, which can cause anemia.
Comprehensive Chemistry Panel: A collection of tests,
including measures of liver damage and kidney function. Ordered
at baseline and on a regular basis, with the frequency depending on
whether you’re taking drugs that can aff ect the liver or kidneys.
Toxoplasma IgG: Determines whether you’ve ever been
infected by the Toxoplasma parasite, which can cause brain lesions
in people with CD4 counts below 100. Ordered at baseline, and
sometimes repeated if your CD4 count is below 100, to determine
whether you need to take prophylaxis.
CMV IgG: Determines whether you’ve ever been infected by
CMV (cytomegalovirus). Usually ordered once at baseline. Not a
critical test since most people’s tests are positive, and there’s not
much you can do with the results anyway.
Lipid panel: Measures your triglycerides and your total, HDL,
and LDL cholesterol, which help determine your risk of heart disease.
Should be ordered aft er an overnight, 12-hour fast at baseline
and approximately once a year, especially if you’re on drugs that
can increase lipid levels.
Fasting glucose (blood sugar): A test for diabetes or insulin
resistance. It’s included in the comprehensive chemistry panel, but
the result is most helpful if you’re fasting. Ordered at baseline and
approximately once a year, especially if you’re on drugs that can
increase blood sugar or cause insulin resistance.
Pap smear: A screening test for cervical dysplasia (abnormal
cells) or cancer in women that looks for abnormal cells caused by
HPV (human papillomavirus). Done at baseline and at least every
year aft er that—more frequently in women with abnormalities. An
abnormal Pap smear should lead to colposcopy, a test that allows
abnormal areas to be biopsied. Anal Pap smears are now being performed
at many centers to look for anal dysplasia and cancer in
both men and women, especially those who have had anal sex. An
abnormal anal Pap smear should be followed by high resolution
anoscopy (HRA).
TB skin test (PPD): A skin test that tells you whether you’ve
ever been exposed to the bacterium that causes tuberculosis (TB). If
the test is positive, you should take nine months of INH (isoniazid)
to prevent active TB, aft er being checked to make sure you don’t
already have it. Th e test should be done at baseline, then every year
in people at high risk for TB. Th e test is less accurate if you have a
low CD4 count, so it should be repeated aft er your CD4 count goes
up on ART.
Urinalysis: Th e best reason to get a baseline urine test is to fi nd
out if you have protein in your urine. Th is is especially important if
PA • September / October 2008 • tpan.com • positivelyaware.com
Positively Aware