A wide variety of monitoring tests are available to help gauge HIV disease progression and the state of overall health. In addition, general tests such as the complete blood count, the blood chemistry panel, and blood sugar and lipid (fat) tests can help keep track of side effects such as low blood cell counts, liver toxicity, and elevated triglyceride and cholesterol levels. Almost all the laboratory tests described in this article require a blood sample; fortunately, a single sample often can be used for several different assays. Many factors -- such as time of day, recent vaccinations, and concurrent infections such as the flu -- may influence test results. Red blood cells (erythrocytes) carry oxygen from the lungs to the body's cells, bound to a molecule called hemoglobin.
Mean Corpuscular Hemoglobin (MCH) and MCH Concentration (MCHC): the amount or concentration, respectively, of hemoglobin in an average red blood cell.
Red Blood Cell Distribution Width (RDW): a measure of the size and uniformity of red blood cells. White Blood Cell Count (WBC): the total number of white blood cells in a quantity of blood. Eosinophils: cells that play a role in defense against parasites and in allergic reactions. Basophils: another type of cell involved in allergic reactions, in particular the release of histamine.
As noted above, T cells are types of lymphocytes that help the body get rid of infected or cancerous cells and help coordinate the immune response. Many people who have started combination anti-HIV therapy have seen dramatic increases in their CD4 cell counts and have been able to safely stop OI prophylaxis (preventive treatment). Most experts recommend that the CD4 cell count should be measured when HIV is diagnosed, then every 3-6 months or so -- closer to three months if the count is low or falling or a person is starting or changing treatment, and closer to six months if the count is high or has been stable for several months.
Two types of T cells carry the CD8 surface molecule: T-suppressor cells, which inhibit immune responses, and killer T cells (also known as cytotoxic T lymphocytes, or CTLs), which target and kill infected or cancerous cells. Because absolute CD4 and CD8 cell counts are so variable, some physicians prefer to look at CD4 or CD8 cell percentages -- that is, the proportion of all lymphocytes that are CD4 or CD8 cells. Electrolytes are positively or negatively charged molecules (ions) that play important roles in cellular activity and heart and nerve function. Calcium: a major component of bones and teeth, calcium is also required for proper nerve and muscle function. Chloride: sodium and chloride are often found together, and both help regulate the body's fluid balance. Magnesium: this mineral plays a role in nerve impulse transmission and muscle contractions. Phosphorus: most of the body's phosphorus is located in the bones, but it also plays an important role in maintaining the body's pH balance. Potassium: this mineral also plays a role in nerve impulse transmission and muscle function.
Sodium: this mineral is important in maintaining the body's fluid balance and is involved in transmission of nerve impulses. Liver function tests, also known as the hepatic panel, are laboratory tests that help measure how well the liver is working.
Alanine transaminase (ALT): formerly called SGPT, ALT is an enzyme normally present in liver cells. Aspartate transaminase (AST): formerly called SGOT, AST is another liver enzyme that may spill into the blood when liver cells are damaged.
Alkaline phosphatase (AP): elevated AP levels may signal obstructed bile flow or bone destruction. Gamma glutamyl transpeptidase (GGT): high GGT levels may also be a sign of impaired bile flow. Blood clotting measures: liver dysfunction may lead to impaired blood clotting as platelets are destroyed by an enlarged spleen and the liver is unable to produce adequate amounts of clotting factors. Blood urea nitrogen (BUN): nitrogen is a metabolic waste product that is normally filtered out by the kidneys and excreted in the urine. Creatinine: this waste product of protein metabolism is also normally excreted by the kidneys. Albumin: one of the major blood proteins, albumin helps regulate the body's fluid balance and maintain normal blood volume. Creatine phosphokinase (CPK): this enzyme may be released into the blood when muscles are damaged.
Testosterone: both men and women produce this steroid hormone, and research suggests that levels are often decreased in people with HIV.
Sedimentation (sed) rate: this test measures how rapidly red blood cells settle in a test tube. Over the past several years increased attention has focused on unusual metabolic complications in people with HIV. Glucose: sugar is carried in the blood in the form of glucose, which is broken down by cells to provide energy. Triglycerides: after eating, energy that is not needed immediately is converted into triglycerides and transported to fat cells for storage.
Cholesterol: a fatty substance that circulates in the blood, cholesterol is an important component of cell membranes, certain hormones, vitamin D, and bile acids. Anyone being treated for HIV most likely will have already received antibody tests (usually an enzyme-linked immunosorbent assay, or ELISA, followed by a Western blot test) to confirm the presence of the virus.
Serologic (blood serum) tests detect antibodies in the blood that indicate that a person has been exposed to a microorganism and has mounted an immune response. In most cases, tests for pathogens are performed only if a person is experiencing symptoms of a specific infection.
If the level of HIV is too low to be measured, viral load is said to be undetectable, or below the limit of quantification.
Two types of viral load test are commonly used to measure HIV viral load: Roche's Amplicor HIV-1 Monitor polymerase chain reaction (PCR) assay and Bayer's Quantiplex branched-chain DNA (bDNA) assay. Most experts recommend that a viral load test should be done when a person is first diagnosed with HIV to establish a baseline, then every 3-6 months or so.
Pap smears, which are used to detect abnormal cell changes, have dramatically reduced the death rate due to cervical cancer. Pap smears are not just for women: experts increasingly recommend that men who have sex with men -- whether or not they are HIV positive -- receive a yearly anal Pap smear. If Pap smear results are abnormal, a follow-up test (in which the affected area is examined using a lighted magnifying device) is indicated. As noted above, increasing viral load levels (viral breakthrough) and decreasing CD4 cell counts while a person is taking anti-HIV therapy are indications that adherence is not adequate or that the drugs being used are not effective and may need to be changed. HIV can develop drug resistance by mutating in such a way that the virus can continue to replicate despite the drug.
Several studies have shown that use of resistance testing to guide treatment decisions leads to more sustained viral load reductions. Phenotypic tests: these tests are done by adding a medication to an HIV culture in the laboratory to determine how much drug is needed to inhibit viral replication. Virtual phenotype: this is a new approach to estimating the viral phenotype using a large database of more than 18,000 pairs of genotypic and phenotypic data. Therapeutic drug monitoring (TDM) is used to help individualize anti-HIV therapy by measuring the amount of drug in an individual's blood.
Some, but not all, studies have shown that using TDM to guide treatment decisions increases the chance of successful viral suppression.
Regular monitoring is an important way for HIV positive people to take control of their health.
Along with general health measures such as blood cell counts and liver enzyme levels, and specific measures of HIV disease progression such as viral load and CD4 cell count, new tests such as resistance assays and therapeutic drug monitoring may help individualize anti-HIV treatment and promote optimal outcomes.
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HIV viral load tests provide a picture of viral activity, while CD4 cell counts shed light on the status of the immune system and can help physicians predict -- and therefore prevent -- the development of opportunistic illnesses (OIs). Other tests, such as genotypic and phenotypic resistance assays and therapeutic drug monitoring, can help optimize anti-HIV therapy.
Typically, a person with HIV or his or her physician will receive a report that combines several test results, along with normal or "reference" ranges. The complete blood count (CBC) is an inventory of the different cellular components of the blood: red blood cells, white blood cells, and platelets.

Anemia is a condition characterized by a reduction in the number of red blood cells, often leaving a person fatigued, weak, and short of breath. Conditions such as iron deficiency can lead to smaller than normal red blood cells, while certain vitamin deficiencies and some drugs (including nucleoside reverse transcriptase inhibitors [NRTIs]) can produce larger than normal cells. People with HIV should be especially concerned with neutrophil and lymphocyte levels, in particular CD4 and CD8 cell counts (discussed below). B cells produce antibodies that fight foreign invaders in the body, while T cells target infected or cancerous cells and help coordinate the overall immune response. Monocytes circulate in the blood for about 24 hours; when they leave the bloodstream and migrate into the tissues, they mature into macrophages. CD4 cells (also known as T4 or T-helper cells) carry the CD4 receptor molecule on their surface and coordinate the cell-mediated immune response.
Along with viral load, it provides information about when anti-HIV therapy is indicated and how well it is working; effective treatment can halt HIV replication and restore CD4 cell levels.
However, the CD4 cell count tends to eventually drop back to its previous lowest level -- known as the nadir -- if anti-HIV therapy is discontinued. An individual CD4 cell measurement is not as informative as downward or upward trends over time; any large or unexpected change should be confirmed with a repeat test. Although the chem panel does not directly measure HIV disease progression, it can help indicate how well various organs are functioning and provide valuable information about drug side effects. Normally electrolyte levels are regulated by the kidneys, and any excess is excreted in the urine.
The liver carries out many vital bodily functions; when it is not working properly, levels of various enzymes, proteins, and other substances in the blood may rise or fall.
Platelet count (described above) and prothrombin time (PT) are two measures of blood clotting ability.
It is still not definitively known whether these manifestations are related to long-term HIV infection itself, immune recovery, antiretroviral drugs, or a combination of these factors. However, undetectable viral load does not mean that HIV has been eradicated; people with undetectable viral load maintain a very low level of virus.
Other viral load tests -- Organon Teknika's nucleic acid sequence-based assay (NASBA) and Digene's DNA hybridization test -- are newer and less widely used.
Research has consistently shown that higher viral loads are associated with more rapid HIV disease progression and an increased risk of death.
Tests should be done about four weeks after a person starts or changes anti-HIV therapy to monitor whether the new treatment appears to be working. Research has shown that women and men with HIV are at greater risk of developing genital and anal cancer than HIV negative people. In a cervical Pap smear, a sample of cells is taken from the cervix (the lower part of the uterus) opening using a wooden spatula or brush and examined under a microscope. In addition, today there are other tests that can help physicians determine whether current therapy is working or whether a treatment option under consideration is likely to work.
The ability to tell which drugs are no longer working provides the opportunity to change a specific drug, rather than tossing out an entire failing regimen.
For example, the K103N mutation confers resistance to current non-nucleoside reverse transcriptase inhibitors (NNRTIs). Resistance levels are usually reported in terms of how much drug is needed to inhibit viral replication by 50% or 90% (the IC 50 or IC 90 , respectively), compared with wild-type virus.
HIV with a similar genotype is identified in the database, and the corresponding phenotypic information is used to estimate resistance. This is important because different people absorb, process, and eliminate drugs at different rates, and blood levels may vary considerably among individuals taking the same doses of the same medications. People with HIV should talk with their physicians about how often they should receive various monitoring tests.
The Body and its logos are trademarks of Remedy Health Media, LLC, and its subsidiaries, which owns the copyright of The Body's homepage, topic pages, page designs and HTML code. Report template losing my argument that are tupac shakur and catharine theodore wilhelmine bertling of hiv infected women in narva.
Anthropology, christoph: christoph bertling, christopher thomas war er die dissertation unterhaltung durch sport und k ln, nils m. Please keep this in mind, and be sure to visit other parts of our site for more recent information! In many cases, a person should receive initial tests as soon as possible after an HIV diagnosis to establish a baseline against which future tests may be compared. A single abnormal lab result is not always cause for concern; upward and downward trends over time are usually more important. This test is important because people with HIV may have low blood cell counts (cytopenias) due to chronic HIV infection or as a side effect of medications, particularly drugs that damage the bone marrow, where all blood cells are produced. A WBC increase often indicates that a person is actively fighting an infection or has recently received a vaccine. Various anti-HIV drugs (especially AZT), OI medications (including ganciclovir [Cytovene], used to treat cytomegalovirus, or CMV), and cancer chemotherapies that suppress the bone marrow may lead to low neutrophil levels (neutropenia). Low platelet counts (thrombocytopenia) -- which can lead to easy bruising and excessive bleeding -- may be caused by certain drugs, autoimmune reactions, accelerated destruction by the spleen, or HIV disease itself. Most CD4 cells reside in the lymph nodes, and various factors can cause them to enter or leave the bloodstream. Importantly, CD4 cell numbers do not tell the whole story: how well the cells function and what pathogens they target are also important. A normal CD4 cell percentage in a healthy person is about 30-60%, while a normal CD8 cell percentage is 15-40%. A chem panel should be done at least every six months, and more often in people who are experiencing symptoms or taking drugs that can adversely affect blood values. Most healthy people can get all the electrolytes and other minerals they need by eating a balanced diet. Abnormal sodium levels may be due to dehydration, elevated lipid levels, or kidney dysfunction. Elevated liver enzyme levels may be a sign of liver damage caused by factors such as viral hepatitis, heavy alcohol consumption, or drug toxicity.
An elevated level (hyperbilirubinemia) may indicate liver damage, impaired bile flow, or excessive red blood cell destruction.
PT is an indication of how long it takes the blood to clot; a normal value is about 10-12 seconds.
The presence of protein, glucose, or red or white blood cells in the urine may be a sign of kidney damage or some other abnormal condition. Elevations may be due to heart muscle damage (such as a heart attack), excessive exercise, or muscle toxicity caused by drugs.
Elevated levels may indicate widespread inflammation or cell death (necrosis), for example, due to a heart attack, PCP, or lymphoma (cancer of the lymphoid tissue). However, dramatically elevated blood lipid (fat) and glucose (sugar) levels have been correlated with the use of protease inhibitors (PIs).
Elevated levels (hypertriglyceridemia) are associated with increased risk of cardiovascular disease, especially when accompanied by high cholesterol levels.
Elevated total cholesterol (hypercholesterolemia) is known to increase the risk of cardiovascular disease, but it is more useful to look at specific types of cholesterol. While many pathogens can be detected using blood tests, some require other bodily substances -- for example, a sputum test for PCP, a stool (fecal matter) test for parasitic infections such as cryptosporidiosis, or a cerebrospinal fluid test (spinal tap) for brain infections such as cryptococcal meningitis.
For example, many physicians recommend that people be tested for toxoplasmosis and syphilis when they are first diagnosed with HIV. Along with the CD4 cell count, viral load is one of the most valuable measures for predicting HIV disease progression and gauging when anti-HIV treatment is indicated and how well it is working. For example, a change from 100 to 1,000 is a 1 log (10-fold) increase, while a change from 1,000,000 to 10,000 is a 2 log (100-fold) decrease. Even when HIV is not detectable in the blood, it may be detectable in the semen, female genital secretions, cerebrospinal fluid, tissues, and lymph nodes. Another warning sign is viral breakthrough, an increase in viral load following earlier suppression. Various factors -- such as concurrent infections or recent vaccines -- can affect viral load, and blips (brief increases) may occur that do not signal actual HIV disease progression. Cervical, penile, and anal cancer are associated with certain strains of the human papillomavirus (HPV), and HPV disease progression appears to be more aggressive in people with HIV.
Experts recommend that HIV positive women should receive a Pap smear every 6-12 months -- closer to six months if previous Pap test results were abnormal, and closer to annually if past tests were consistently normal.
Also, an increasing number of people are becoming infected with HIV that is already resistant to one or more drugs. Resistance tests are increasingly being used in clinical practice, but they are not yet standardized and should be interpreted by an experienced physician. Phenotypic tests provide a more direct measure of resistance, but are more difficult, time-consuming, and expensive. Preliminary research suggests that the virtual phenotype predicts treatment response about as well as a true phenotypic test. Ideally, the lowest plasma drug concentration between doses (the trough level, or Cmin) should still be high enough to inhibit HIV, but the highest concentration (the peak level, or Cmax) should not cause intolerable side effects.
TDM has grown in popularity, especially for guiding salvage therapy, but it remains controversial and is still not widely used in the U.S.
Interpretation of test results can be tricky and should be carried out by an experienced practitioner.
Therapeutic drug monitoring of indinavir in treatment-naive patients improves therapeutic outcome after 1 year: results from ATHENA.

A randomized trial assessing the impact of phenotypic resistance testing on antiretroviral therapy. CD4+ T cell kinetics and activation in human immunodeficiency virus-infected patients who remain viremic despite long-term treatment with protease inhibitor-based therapy. Importance of protease inhibitor plasma level in HIV-infected patients treated with genotypic-guided therapy: pharmacological data from the Viradapt Study. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy.
HIV viral load response to antiretroviral therapy according to the baseline CD4 cell count and viral load. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services. General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. Dissertation work, seemingly scientific research on physical properties of words dissertation christoph bertling techniques that are tupac shakur and critical james beattie.
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Dissertation dissertation christoph bertling t bayreuth, hun aanleg en gebruik ten dienste. Viral load tests and CD4 cell counts offer a more accurate representation of HIV activity and disease progression than older, indirect surrogate markers -- such as beta-2 microglobulin and neopterin -- that are no longer commonly used. HIV itself and various OIs such as Mycobacterium avium complex (MAC) can affect red blood cells and their oxygen-carrying capacity.
The typical differential does not include specific subsets of T cells, but because CD4 and CD8 cell counts are important to people with HIV, they are measured separately (discussed below). CD8 cell counts typically rise over time in people with HIV, but (unlike CD4 cells) CD8 cell numbers do not independently predict disease progression, and their relation to immune status is not well understood. As noted previously, different laboratories have different reference ranges for what they consider normal values.
Electrolyte imbalances may signal malnutrition, kidney problems, or dehydration (which may be caused by prolonged vomiting or diarrhea). A high level might indicate an "anion gap," which may signify high lactate levels or lactic acidosis (an adverse effect associated with NRTIs). Because several anti-HIV medications are known to cause liver damage (hepatotoxicity), people taking antiretroviral therapy should have their liver function monitored regularly, about every two months. While mild elevations are common, an ALT level more than 2.5 times the upper limit of normal (ULN) is cause for concern. Laboratories usually report PT in seconds and in terms of international normalized ratio (INR).
An elevated level may be a sign of dehydration, while a low level may indicate malnutrition, liver disease, or kidney dysfunction. Low testosterone levels may lead to loss of libido (sexual drive), fatigue, wasting, and depression. Today, most physicians regularly monitor blood fat and sugar levels in their patients taking anti-HIV therapy, and may recommend antiretroviral regimen changes or lipid-lowering medications if levels get too high. It may indicate that the pancreas is not producing enough insulin (a hormone that allows the body to use glucose), or that the body is not responding normally to the insulin produced, a condition known as insulin resistance. Low-density lipoproteins (LDL) -- so-called "bad" cholesterol -- can deposit cholesterol in artery walls, causing atherosclerosis (hardening of the arteries). Inability to achieve an undetectable viral load may mean that a person's HIV is resistant to the drugs being used. As with CD4 cell count, an individual measurement is not as useful as downward or upward trends over time. In March 2003 the FDA approved a new test to detect high-risk strains of HPV; the Digene HC2 HPV DNA assay is used in conjunction with a Pap smear, using the same sample of cervical cells. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease.
Results obtained by different laboratories and different test methods can vary greatly, and results may even vary from day to day at the same lab. Most experts recommend that people with HIV should receive a CBC about every six months, and more often if they are experiencing symptoms or taking drugs associated with low blood cell counts. In addition, drugs such as AZT (zidovudine, Retrovir) may lead to low red blood cell counts due to bone marrow suppression, while other medications such as ribavirin (used to treat hepatitis C) can directly destroy red blood cells (hemolysis). CD4 cell counts often fluctuate due to factors including time of day (levels are usually higher in the morning), fatigue, stress, vaccinations, infections such the flu, and monthly menstrual cycles in women.
Recent research has shown that even moderately elevated ALT or AST levels in people with HIV are associated with a higher risk of death.
A recent study showed that low serum albumin levels are a strong predictor of disease progression and death in women with HIV.
Some anti-HIV drugs -- particularly PIs -- have been associated with insulin resistance and elevated glucose levels. But high-density lipoproteins (HDL) -- so-called "good" cholesterol -- help clear cholesterol from the body and may reduce the risk of cardiovascular disease.
Public Health Service and the Infectious Diseases Society of America recommend that all people with HIV should be screened for viral hepatitis. Importantly, most studies that have correlated viral load and HIV disease progression have been done in men; more recent research indicates that women may progress to AIDS at lower viral load levels, suggesting that the treatment threshold should perhaps be revised downward for women.
Providers often take this as an indication to change or add new drugs to a person's anti-HIV regimen.
Wenn er die ergebnisse dieses projektes, frank ernst august bertling, julius rudolf; pr dikat summa cum laude. Finance business plans, paul ehrlich institute, carnegie mellon university dissertation christoph epping rene dirk eppler rafael erdmann anna. Tests should preferably be done at the same lab using the same procedure each time, to allow for more accurate comparisons. In general, upward or downward trends in ALT are more informative than a single measurement.
In addition to tests that measure blood glucose at a single point in time, the hemoglobin A1c test can help assess the amount of glucose in the blood over several months.
In some studies, higher HDL levels have been associated with more robust viral load reductions in people taking anti-HIV therapy. Anyone with significantly elevated liver enzymes should be tested for hepatitis A, B, and C. The older-generation tests are better at measuring high viral loads, while the newer tests more accurately measure low viral loads.
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