This article is part of Infectious Disease Advisor’s In-Depth HIV coverage of the IDWeek 2020 meeting.
Amon certain groups of people with HIV (PWH), it may be prudent to delay or eliminate liver, renal, and lipid testing, as those younger than 40 years have low risk of clinically significant renal and liver function abnormalities, according to the data presented at the IDWeek, held virtually from October 21 to 25, 2020.
Investigators reviewed the charts of 261 PWH with at least 2 clinic visits and 1 set of comprehensive metabolic panels 7 days after initiating antiretroviral therapy (ART). They found that 221 patients (85%) had no laboratory abnormalities while on ART. Glomerular filtration rate (GFR) less than 60 mL/min was found in 10% of patients and represented the most common abnormality. Diabetes mellitus (DM) was associated with an increased risk of GFR less than 60 mL/min (estimated rate ratio, 2.23; 95% CI, 1.17-4.25) while age younger than 40 years was associated with a decreased risk of GFR less than 60 mL/min (estimated rate ratio, 0.02; 95% CI, 0.00-0.12).
In 53% of cases where GFR was less than 60 mL/min, aspartate aminotransferase (AST) was more than 2 times the upper limit of normal, or alanine transaminase (ALT) was more than 2 times the upper limit of normal, no action was taken; 18% of the time, there was repeat testing. The most common actions after a lipid panel result were to calculate a 10-year cardiovascular risk score (32%) and to add a statin (18%). Age 40 years or older was strongly associated with taking action after lipid panel results (estimated rate ratio, 9.1; 95% CI, 3.3-24.9). ART was changed in 7 individuals based on GFR, AST, ALT, or lipid panel results. Poor outcomes, including cerebrovascular accident, acute renal failure, end stage renal disease, congestive heart failure, myocardial infarction, and death were observed in 4 individuals. Contributing factors to poor outcomes were hypertension, DM, and hypercholesterolemia.
Investigators conclude that individuals younger than 40 years of age have a low risk of clinically significant renal or liver abnormalities and rarely require actions to be taken after test results. Therefore, during the COVID-19 pandemic and beyond, it may be prudent to delay or cease this testing. Doing so could eliminate exposure, reduce costs, and reduce patient anxiety.
York LD, Fisher JM, Malladi L, et al. Antiretroviral laboratory monitoring and implications for HIV clinical care in the era of COVID-19 and beyond. Presented at: IDWeek 2020; October 21-25, 2020. Poster 927.