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Lab tests needed for patient living with HIV and AIDS (CD4 ct below 200) - better to quarantine at home or go to lab to do lab tests. due?

  • 1.  Lab tests needed for patient living with HIV and AIDS (CD4 ct below 200) - better to quarantine at home or go to lab to do lab tests. due?

    Posted 04-24-2020 03:25
    please kindly share your thoughts RE: better to have patient living with HIV and CD 4 count below 200 leave home and go do lab tests or better to have this patient stay at home/quarantine for now? 

    Thank you for your anticipated input. 


    Richel Strydom, MD, MPH
    909-727-0514


  • 2.  RE: Lab tests needed for patient living with HIV and AIDS (CD4 ct below 200) - better to quarantine at home or go to lab to do lab tests. due?

    Posted 04-25-2020 04:03
    Ya that is a tough decision.  Were arvs recently started and is there a possibility they wouldn't work because the patient was say treatment experienced or new interacting meds?

    In that situation I feel like it's more worth it to know if someone is responding to treatment rather than to make sure the patient was maintaining viral suppression or to document improvement in cd4.

    Anything else is probably determined by what else medically is going on with the patient, other conditions, current OI, etc.

    And then the above is predicated on the assumption that the patient would be at high risk for getting covid (ongoing community transmission, how they physically get to lab) and that if they did get covid, there would be a high risk for severe disease.  Which makes sense given severe immunosuppression, but I'm interested if anyone is aware of data at this point for plwh who get covid?

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    Alexander Cyganowski
    Gallup NM
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  • 3.  RE: Lab tests needed for patient living with HIV and AIDS (CD4 ct below 200) - better to quarantine at home or go to lab to do lab tests. due?

    Posted 04-26-2020 01:43
    I probably have the patient to get labs done with proper precaution considering his/her CD4 count.





  • 4.  RE: Lab tests needed for patient living with HIV and AIDS (CD4 ct below 200) - better to quarantine at home or go to lab to do lab tests. due?

    Posted 04-27-2020 02:14
    I actually don't think this is that controversial if the patient has been successful with this regimen up until now (at least one undetectable viral load) , and is still adherent. The only thing that matters is adherence, not rechecking viral load or CD4 in the next 3-6 months. I would recommend stay at home, especially with low CD4 unless symptomatic, and receive periodic phone or telehealth visits to reinforce adherence. If doses aren't missed, he/she will be undetectable in 6 months or a year. More frequent checking won't change that.



    Arthur Moswin, MD
    Medical Director, HIV Program





  • 5.  RE: Lab tests needed for patient living with HIV and AIDS (CD4 ct below 200) - better to quarantine at home or go to lab to do lab tests. due?

    Posted 04-26-2020 13:35
    I agree , this is tough, but.... If their viral load is undetectable and has been for a while and they are known to be adherent, I am willing to wait to collect labs because for these clients, their immune systems are not really changing that fast anyway.  I am comfortable doing a telephone or telehealth visit with these stable patients. What about the rest of you guys?





  • 6.  RE: Lab tests needed for patient living with HIV and AIDS (CD4 ct below 200) - better to quarantine at home or go to lab to do lab tests. due?

    Posted 04-26-2020 13:40
    This is tough, but... for the clients with the low CD4 count but are undetectable and have been undetectable for a while, I am willing to delay collecting labs and perhaps do a telehealth or telephone visit instead.
    However, I agree that if there are other issues of adherence, tolerance, or resistance, it may be necessary to collet labs regardless of the current Co Void epidemic. 





  • 7.  RE: Lab tests needed for patient living with HIV and AIDS (CD4 ct below 200) - better to quarantine at home or go to lab to do lab tests. due?

    Posted 04-27-2020 08:28
    I think 10 or 20 years ago the labs would have been more helpful.  At this point labs are mostly an adherence check. Our meds are so effective and so much easier to take that the only thing that really matters is adherence and even that does not need to be as high as it did in the past.  What would you do differently if the CD4 was still under 200? or if the HIV RNA was detectable. The only patients I have had come in for labs are new patients for baseline labs. Patients that are just now due for labs - I think can easily go another month or two.  I have a few patients that have not had labs in 6-9 months, normally I'd want them to come in but then again, what's the real difference between 9 and 10 months since their last labs.  If the viral load is detectable, generally we'd just be talking to patients more about adherence.  Resistance to dolutegravir or bictegravir based regimens are very rare even with adherence issues. It may also depend on the prevalence of COVID19 in your area - assuming you have enough testing to know that.  In Boston, COVID19 infections are widespread and I am not having anyone come in for routine labs.

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    Jonathan Pincus
    Codman Square Health Center
    Milton MA
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