Johns Hopkins Guides provide diagnosis, management, and treatment guidance for infectious diseases, diabetes, and psychiatric conditions. Explore these free sample topics:
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- HPI: include date of Dx, date of infection if known, nadir CD4, peak VL, OIs and Sxs (stage HIV)
- PMH: include prior TB or exposure, PPD history, chicken pox, shingles, residence and travel, mental health (e.g. depression screening), weight change.
- Meds: ARV history (if any), OTCs, dietary supplements, methadone
- Vaccinations: dT, Pneumovax, hepatitis B and A, and flu (seasonal)
- Substance use: street, prescribed, recreational, needle-sharing, alcohol use (with CAGE or AUDIT), smoking
- Sexual history: practices, barrier use, HIV status of partners, STDs
- Social: Family/partner violence, HIV status of partner & children (if any) social support, diet, exercise, education
- Allergies: sulfonamides, penicillin, hypersensitivity to prior ARVs and any other relevant medication allergies.
- Family history: early CVD, diabetes, hyperlipidemia
- Women: menstrual history, contraception, infertility, pregnancy history, childbearing plans , osteoporosis Dx and treatment.
- Women: Include pelvic/rectal, breast exam. Condyloma, HSV, fungal, cervical dysplasia (PAP), Trichomonas, Chlamydia and GC, HPV
- Men: Include prostate/rectal, genital exam. Condyloma, HSV. Consider anal PAP (HPV, dysplasia), especially in MSM.
- Skin: KS, fungal, folliculitis, prurigo nodularis
- Body habitus: fat redistribution (neck, face, breasts, buttocks, abdomen, extremities)
- Oropharynx: candidiasis, OHL, KS, aphthous ulcers, periodontal disease.
- Lymphadenopathy: localized requires evaluation; generalized common in HIV+
- Neurologic: cognitive dysfunction , neuropathy, focal neurologic findings
- HIV serology: if lab confirmation (serology, elevated VL) not available
- CD4 count: stage HIV. Every 3-6 mos if not on ART
- VL (plasma HIV RNA): stage HIV. Every 3-4 mos if not on ART
- RPR: repeat annually or more often in pts at high risk
- Chemistries: include AST, ALT, BUN, creatinine, bilirubin, alk phos, albumin, electrolytes
- CBC with differential
- Fasting blood glucose (x2): Consider 2-hr OGTT if abnormal.
- Fasting lipid profile (TG, TC, HDL, LDL): all or prior to starting ARVs
- Urinalysis: Proteinuria may indicate HIV-related or other early renal disease (e.g. HTN, DM).
- C. trachomatis and N. gonorrhea by NAAT (all sexually active pts or w/ Sx).
- HIV genotype (if VL >1000). Indicated regardless of need for ART, as mutations may disappear.
- G6PD: consider before use of dapsone, primaquine, sulfonamides, especially in pts at risk (African or Mediterranean descent)
- Hepatitis serologies: A (total anti-HAV Ab), B (HBsAg, HBsAb or HBcAb, with HBeAg/HBeAb and HBV DNA if HBsAg+; HBV DNA if HBcAb+/HBsAb- or if elevated LFTs ), and C (anti-HCV, with HCV PCR if anti-HCV+ or negative with risk factors or elevated LFTs).
- anti-Toxoplasma IgG: evaluate for latent Toxoplasma infection. Counsel seronegative pts on avoiding exposure
- anti-CMVIgG: in non-MSM, non-IDU. (MSM and IDU highly likely to be seropositive)
- anti-varicella IgG: in pts with no history of chicken pox or shingles
- AM Testosterone level (total): if clinical indication (weight loss, fatigue, loss of libido)
- Pregnancy test: missed menses
- PSA: Recommended for men >40 yo (AUA). Routine screening not recommended (ACA and USPSTF); no PSA screening after age 75 (ACS)
- Ophthalmologic fundoscopy: if CD4 < 50 or with visual Sx
- Chest x-ray: If PPD+ or if clinically indicated. Not routine.
- Cervical PAP: repeat at 6 mos, then annually if negative. Refer for colposcopy if abnormal.
- Anal PAP: consider, especially in MSM or women with history of anal intercourse. Repeat every 1-3 years. Refer for high resolution anoscopy if abnormal.
- Anthropomorphic measures: skin-fold, extremity/neck/abdomen circumference. BIA or DEXA: not standardized; BIA can’t distinguish visceral vs SQl fat. DEXA best for SQ, not visceral fat.
- PPD: repeat annually in pts at risk; repeat after immune reconstitution on ART if initial PPD negative with low CD4.
- Vaccinations: dT (every 10 yr), Pneumococcal (one time revaccination 5 years after 1st dose; consider repeat every 5 yrs though efficacy unknown, influenza (annual), hepatitis B and A (if non-immune). Vaccine efficacy greater with higher CD4 (>200), undetectable VL. Defer vaccination in pts about to start ART.
Other Health Maintenance
- Breast exam. Mammogram in women over 40 (every 1-2 yrs; annual after age 50)
- Colonoscopy: over 50 (repeat in 10 years if negative)
- PSA: High false+, not routine. Age 50-70 most likely to benefit, particularly if African-American or 1st degree relative with prostate cancer, but risk of false + should be first discussed
- Bone density: women > 60, or if high-risk for early osteopenia in women, or high-risk (early menopause, steroid use, hypogonadism).
- ECG: if clinically indicated. Not routine.
- PFTs: if clinically indicated. Not routine.
- ART: Preparation for life-long treatment, adherence, adverse effects, readiness before starting
- Sexual practices, barrier and contraceptive use, pregnancy plans
- Substance and alcohol use and treatment
- Smoking cessation, diet, exercise, dietary supplements
- Social support, housing, living assistance