HIV: WHAT TESTS YOU SHOULD HAVE
All persons diagnosed with HIV infection should have a skin test and chest X-ray to check for tuberculosis. Those determined to be positive must have treatment to prevent a reactivation of the disease, to which they will be more susceptible once infected with a virus that suppresses the immune system. A test for syphilis (the Venereal Disease Research Laboratory [VDRL] test or rapid plasma reagin [RPR] test) must also be done for the same reason.
Testing for toxoplasmosis should also be carried out after the initial diagnosis. As will be discussed later, people who have toxoplasma antibody have a history of infection, even though they may not remember being infected, since infection is frequently symptom free. This puts them at risk for reactivation of the infection as their medical condition worsens. Immunization against pneumococcal pneumonia, influenza (yearly, in the fall), and hepatitis B for sexually active persons is also recommended.
The health care provider of an infected person will use the CD4 or T-helper-cell count and monitor the person’s physical condition to decide on the best time to start the various medications available to treat HIV infection. Then again, a person may decide that he or she does not ever want to start these medications.
There can be significant variation in an individual’s CD4 count, even on a daily basis. A “normal” CD4 count is greater than 500; however, if a person without HIV infection experiences a serious illness or stress, this number can temporarily drop below 500. Similarly, most HIV-infected people will have CD4 counts greater than 500 during the early part of their infection. This daily variation can sometimes be up to 150 points in HIV-positive individuals, and even more in those who are HIV negative. A CD4 count that is significantly different from the previous count should be rechecked, ideally at the same time of day that the first count was obtained, to determine if the variation is real. This is a situation in which the newer viral load test can be useful.
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