1. + Understanding HIV-Related Lab Tests Jordan E. Lake, MD, MSc AAHU August 27, 2014

2. + Labs 101 “Why do you need to take so much blood!?!”

3. + Labs 101: Three Questions What labs do we draw? What do these labs tell us? How often do we need these labs?

4. + T cells 101 T cell: a type of immune system cell T cells become infected by HIV when the virus recognizes proteins on the T cell surface One of these proteins is called CD4 Doctors and patients may talk about T cells or CD4 cells (same thing)

5. + T cells 101 The number of T cells tells us how healthy the immune system is (normal ≥700 cells/mm 3 ) As the immune system becomes weaker from HIV, the number of T cells goes down (they die and your body can’t make more)

6. + T cells 101 When T cells are not infected with HIV, they help to fight infection and cancer As T cell number decreases and T cells become weaker, their ability to “help” goes down

7. + http://www.southsudanmedicaljournal.com/archive/2009-08/untitled-resource.html

8. + T cells 101 What does the number of T cells tell me? <200cells/mm 3 : AIDS, immune system very weak 200-349cells/mm 3 : immune system still weak, some infections more common 350-499cells/mm 3 : immune system is getting stronger ≥500cells/mm 3 : Ideal

9. + HIV Viral Load 101 Viral load (VL) is the amount of HIV in the blood in copies/mL Without HIV medicines, VL is high With effective HIV medicines, no new HIV viruses are made, and the VL goes down

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11. + HIV Viral Load 101 Q: What does “undetectable” mean? A: Undetectable means there is less HIV in the blood than the test can detect, NOT that the virus is gone from the body -The virus lives in many places in the body other than your blood -Cells in the blood can be infected with HIV but not release virus into the blood

12. + Where is the HIV Virus in the Body?

13. + How Do HIV Medications Affect T cells and the HIV Viral Load?

14. + Effective HIV Medicines Stops new HIV virus from being made Stops T cells from dying Allows the body the chance to make new T cells

15. atripla.com

17. + HIV Genotype 101 The genotype tells us what medications the HIV virus is sensitive to It is specific to each person, and helps doctors choose medication regimens Also called a “resistance test”

18. + HIV Genotype 101

19. + When To Check Labs T cell count: at diagnosis, then every 3-6 months HIV Viral Load: at diagnosis, 4 weeks after starting HIV medicines, 12 weeks after starting medicines, then 2-3 times per year Genotype: at diagnosis, if VL going up on medicines and resistance suspected

20. + Other Labs We Check Kidneys: blood creatinine, urinalysis Liver: AST, ALT, bilirubin Anemia: hemoglobin Immune system: white and red blood cell counts and characteristics Cholesterol: lipid panel STIs: RPR, Gonorrhea/Chlamydia as appropriate for individual patient Viral hepatitis: Hepatitis A,B, and C at diagnosis, Hepatitis B and C if liver abnormalities, plus Hepatitis C antibody yearly for MSM

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