Baseline Laboratory Evaluation for Adults and Adolescents, Pregnant Women, and Children
2023 ART Guidelines
Creatinine and eGFR if TDF Used
Cryptococcal Antigen Test (CrAg) if CD4 < 100 cells/μL
The following baseline laboratory investigations should be performed routinely before a client initiates ART. Clients are not required to wait for the results of the baseline investigations prior to starting ART, but results should be checked at the next visit.
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Confirm HIV test result
Purpose: To confirm HIV status for those without documented HIV status.
Adolescents (10-19 years) and Adults, Pregnant Women, & Children (<10 years): Applicable to all.
CD4 cell count/%
Purpose: To identify eligibility for CPT.
Adolescents (10-19 years) and Adults, Pregnant Women, & Children (<10 years): See Indications for Starting and Stopping Cotrimoxazole Preventive Therapy
Purpose: To identify eligibility for cryptococcal antigen (CrAg) screening.
Adolescents (10-19 years) and Adults & Pregnant Women: A reflex CrAg test will be done automatically by the laboratory on all CD4 counts < 100 cells/μL
Creatinine and eGFR if TDF used
Purpose: To assess renal insufficiency
Adolescents (10-19 years) and Adults & Pregnant Women:: See Assessing Renal Function
Haemoglobin (Hb)
Purpose: To identify and manage anaemia; to determine eligibility for zidovudine (AZT) where necessary
Adolescents (10-19 years) and Adults: If Hb is low, do a full blood count (FBC). Characterise according to mean corpuscular volume (MCV) as either microcytic, normocytic, or macrocytic and manage accordingly1
Pregnant Women: Treat with ferrous sulphate tds if Hb < 10 g/dL. Refer if < 8 g/dL and symptoms, if anaemia diagnosed at 36 weeks gestation or later, or if no response to treatment
Children (< 10 years): Children < 5 years: Treat with iron supplements and deworm the child1 .Children ≥ 5 years: Do FBC. Characterise according to MCV and manage accordingly1
1 As outlined in the PHC EML 2020
GeneXpert (MTB/Rif Ultra)
Purpose: To diagnose TB
Adolescents (10-19 years) and Adults, Pregnant Women & Children (< 10 years) : For any client with a positive TB symptom screen.
For people living with HIV, regardless of TB symptoms:
- At the time of HIV diagnosis;
- On enrolment in antenatal care for pregnant women.
Cryptococcal antigen test (CrAg) if CD4 < 100 cells/μL
Purpose: To identify asymptomatic clients who need pre-emptive fluconazole treatment.
Adolescents (10-19 years) and Adults: A reflex CrAg test will be done automatically by the laboratory on all CD4 counts < 100 cells/μL.
If CrAg-negative, no fluconazole is required.
If CrAg-positive, the client will require treatment of the infection. All CrAg-positive clients should be referred for a lumbar puncture, regardless of symptoms.
Pregnant Women: All pregnant women with a positive CrAg should be referred for a lumbar puncture, regardless of symptoms. The results of the lumbar puncture and further management should be discussed with an expert, or one of the Helplines.
Cervical cancer screening
Purpose: To identify women with cervical lesions and manage appropriately.
Adolescents (10-19 years) and Adults: All HIV-positive women should be screened for cervical cancer at diagnosis and subsequently every 3 years if the screening test is negative. If the cervical screening results suggest a possible abnormality of the cervical cells, then a clear plan for further investigation and treatment (e.g. colposcopy and LLETZ procedure) should be determined according to the local referral guidelines.
Pregnant Women: Pregnancy does not preclude screening for cervical cancer and it can be performed up to 20 weeks of gestation. If the cervical screening results suggest a possible abnormality of the cervical cells, then a clear plan for further investigation (e.g., colposcopy) should be determined according to the local referral guidelines.
HBsAg
Purpose: To identify those co-infected with hepatitis B (HBV)
Adolescents (10-19 years) and Adults & Pregannt Women: If positive, exercise caution in stopping TDF-containing regimens, to prevent hepatitis flares.
2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates
June 2023 Version 4
Upload date: 28/07/2023