Monitor Your Health
Lab tests can be helpful tools.
HIV-positive people with a falling or low T-cell count and a high viral load are at greater risk for developing HIV-related opportunistic infections. To monitor your health and progress on a treatment regimen, a range of laboratory tests are used (see "New HIV Tests"). Here are the basics:

• Complete physical exam.
• Baseline T-cell (CD4+) and viral-load blood tests (see below) prior to beginning any therapy. Both are recommended every three to four months if you're taking HIV meds.
• Basic medical tests: routine blood chemistry (including liver and glucose levels, neurologic-function test, urinalysis); chest X ray.
• STD screening; if negative, discuss past exposure with your doctor.
• Women: gynecological screening and Pap smears.
• An anergy skin panel to test your immune responses.
• Baseline toxoplasmosis IgG test; also tests for MAC and CMV.
• Baseline tuberculosis PPD: If positive at 5 mm, treat (see "HIV Illnesses").
• Screening for hepatitis A, B, and C; shots for A and B (if negative for syphilis).
• Eye exam.
• Dental exam: Fill any cavities because HIV can grow in them.
• Baseline nutritional level exam and diet review by a nutritionist.
• A flu shot every October. (Shot may cause transient viral-load rise so wait four to six weeks before getting a viral-load test again.)

T-Cell Test: A T-cell (or CD4+) test measures both the absolute count of and the ratio of your immune T-cells.The normal T-cell range is 300-1200 T-cells. A person with more than 500 T-cells is considered at low risk for HIV symptoms. If your T-cells fall below 500, consider this a warning sign. A drop below 200 puts you at high risk for HIV-related infections. A tip: Watch for trends over time; T-cells levels can fluctuate.

Viral-Load Test: A viral-load test measures the amount of virus in your blood plasma. A branched DNA (bDNA) viral-load test measures down to 400 copies per milliliter of blood; a reverse transcriptase polymerase chain reaction (RT-PCR) tests down to 500 copies. An "un-detectable" viral load falls below these levels. More sensitive viral-load tests measure down to 50 copies. New proviral tests are also coming (see "New HIV Tests").

Using Viral-Load Tests:

• Before starting treatment, get two initial viral-load measurements two weeks apart to establish baseline viral activity.
• Measure viral load again two to four weeks after therapy begins or when changing regimens.
• Use the same type of viral-load test each time.

Short-Term Goal: A one-log (tenfold) drop in viral load within four weeks.

Long-Term Goal: Keeping viral load as low as possible.

Drug Failure: A viral load rebound after four months to any level or to within 0.3-0.5 log of pre-treatment level.