apsul
Uji Laboratorium yang Dianjurkan untuk Kasus Baru HIV Positif
Test
Comment
Complete blood count
Anemia may contraindicate use of zidovudine
Electrolytes, blood urea nitrogen, creatinine, fasting blood sugar
Abnormal renal function may contraindicate use of tenofovir or indicate
need for adjustment of renally excreted nucleoside or nucleotide
analogues; baseline presence of diabetes may contraindicate use of
protease inhibitors, which can cause insulin resistance
Bilirubin, alkaline phosphatase, aspartate aminotransferase,
alanine aminotransferase
Indinavir and atazanavir can elevate indirect bilirubin levels. Abnormal
liver-enzyme levels may indicate need for further workup, may
influence choice of antiretroviral agents, which carry risk of
hepatotoxicity, or both
Creatine kinase
Elevated value may reflect, most commonly, exercise or underlying HIV
myopathy; a baseline value is helpful, to monitor zidovudine therapy,
which may cause drug-induced myopathy
Amylase, lipase
Baseline values may be helpful for making decisions regarding use of
drugs (e.g., didanosine) that carry risk of pancreatitis.
Fasting lipid profile
Abnormal baseline values may indicate need for dietary therapy, drug
therapy, or both, or possible avoidance of therapy with certain protease
inhibitors
Serologic tests for syphilis (e.g., plasma reagin test)
Evidence of past or recent exposure requires treatment unless there is
documentation of adequate course of treatment.
Serologic tests for hepatitis A, B, and C viruses
If negative, counseling to prevent acquisition of all three viruses and
vaccination for hepatitis A and B viruses are indicated. If active
infection with hepatitis B or C virus, or both, is present, decision
should be made about specific treatment and its relation to
antiretroviral therapy
Toxoplasmosis titer
If negative, counseling to prevent acquisition of Toxoplasma gondii
(including avoidance of undercooked meat and of cat feces) is
indicated. If positive, and CD4 cell count is <100 per mm3, primary
prophylaxis is indicated. (patients with very advanced HIV infection
may lose antibody to T. gondii.)
CMV titer
If negative, counseling is indicated to prevent acquisition of virus
through intimate contact or blood transfusion. If blood products are
needed, screening should be considered, to prevent CMV acquisition.
Whether there is a routine need for this test is debatable, given the
decreased incidence of CMV-associated disease with the use of potent
antiretroviral therapy.
Cervical Papanicolaou smear
Important, given the prevalence of HPV infection and increased risk of
cervical neoplasia.
Anal screening for HPV
No consensus recommendation exists, but consideration of Papanicolaou
smear, HPV DNA test, or both, is reasonable, given associated risk of
anal carcinoma.
Tuberculin skin test
If positive (induration 5 mm) and active tuberculosis is ruled out,
isoniazid therapy for nine months should be considered.
Electrocardiography
Baseline tracing may be important, given potential for increased
cardiovascular risk associated with antiretroviral therapy (especially
some protease inhibitors). Atazanavir can prolong PR interval.
Chest radiography
Important to consider obtaining a baseline film, owing to numerous
HIV-related complications that can manifest as pulmonary disease.
*Because of potential past exposure to pathogens that may reactivate with immunosuppression, additional baseline laboratory screening tests to consider in persons
with newly diagnosed HIV infection may include titers for Histoplasma capsulatum, Coccidioides immitis and Blastomyces dermatitidis. If these tests are
negative, counseling (e.g., regarding travel and recreation) to avoid acquisition should be considered. If positive, the awareness that risk increases as immunosup-
pression worsens may help in the management of HIV infection. In the United States, histoplasmosis is endemic in the Mississippi River Valley, Puerto Rico, and
foci in other parts of the country; coccidioidomycosis is endemic in central California and the Southwest; and blastomycosis is endemic in the Southeast.
Blastomycosis is relatively rare in patients with AIDS, so the role of testing for this infection is particularly uncertain. Stool examination for Strongyloides
stercoralis also should be considered in patients with a history of travel to or residence in tropical or semitropical areas. If positive, treatment is indicated to avoid
the potential for future development of hyperinfection syndrome with advanced immunosuppression. However, routine testing cannot be recommended on the basis
of available data. CMV denotes cytomegalovirus, and HPV human papillomavirus. Data are from the Department of Health and Human Services and Aberg et al.
Cermin Dunia Kedokteran No. 151, 2006
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