Which tests are performed prior to initiation of antimicrobial prophylaxis for the prevention of opportunistic infections in patients with HIV infection?

Answer

On the patient's first visit, serologies for syphilis; hepatitis A, B, and C; and toxoplasmosis should be obtained. Although the incidence of CMV disease, including retinopathy, has declined significantly, it is recommended that patients with HIV who are not at high risk for CMV infection (ie, men who have sex with men, people who intravenously inject drugs, or patients who are exposed to children in daycare centers) be screened to confirm that they are CMV-negative (BIII recommendation).^[33] Such HIV-positive, CMV-negative persons would be instructed to limit exposure to CMV by using latex condoms and other barrier precautions (AII recommendation), be informed of the risk for acquisition in daycare facilities (BII recommendation), and be instructed to accept only CMV-seronegative or leukocyte-reduced blood products in nonemergent situations (BIII recommendation).^[1]

Urine chlamydial and gonorrheal nucleic acid amplification testing should be performed in all patients with newly diagnosed HIV infection. Similarly, patients who participate in oral or anal receptive intercourse should undergo site directed chlamydial and gonorrheal nucleic acid amplification testing. Women should be evaluated for trichomoniasis. A purified-protein derivative (PPD) skin test should be placed unless a previous positive result for TB has been documented. An interferon-gamma release assay may be sufficiently sensitive for 1-step testing, but false-negative test results are common in advanced immunodeficiency.^[1]

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