The Laboratory

■ The HIV test is checked in a cooperating laboratory. Western blot is only positive if gp41+120/160 or p24+120/160 react. Cross-reactive antibodies, for example in the case of collagenosis, lymphoma or recent vaccination can lead to false-positive test results.

■ Complete blood count: 30-40 % of all HIV patients suffer from anemia, neutropenia or thrombopenia. Check-up at least every 3-6 months, asymptomatic patients included.

■ CD4 cell count at the beginning and every 3-4 months thereafter. Allow for variations (dependent on time of day, particularly low at midday, particularly high in the evening; percentage with less fluctuation; HTLV-1 co-infection leads to higher counts despite existing immunodeficit).

■ Electrolytes, creatinine, GOT, GPT, yGT, AP, LDH, lipase.

■ Blood sugar determination in order to assess the probability of metabolic side-effects when undergoing antiretroviral therapy.

■ Lipid profile, as a baseline determination to check the course of metabolic side-effects when undergoing antiretroviral therapy.

■ Urine status (proteinuria is often a sign of HIV-associated nephropathy).

■ Hepatitis serology: A and B, in order to identify vaccination candidates; C, in order to possibly administer HCV therapy prior to ART; perhaps also G, since this coinfection seems to have a positive effect on the course of HIV infection.

■ Toxoplasmosis serology IgG. If negative: important for differential diagnosis, if CD4 cells <150/^l - prevention of infection (no raw meat). If positive: medical prophylaxis if necessary.

■ CMV serology (IgG). For the identification of CMV-negative patients. If negative: important for differential diagnosis, then information about prevention (safe sex). In cases of severe anemia, transfusion of CMV-negative blood only. If positive: prophylaxis if necessary.

■ Varicella serology (IgG). If negative: in principle, active vaccination with attenuated pathogens is contraindicated, but at > 400 CD4 cells/^l it is probably safe and perhaps useful.

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