Hematologic, hepatic, renal, and lipid laboratory monitoring after initiation of combination antiretroviral therapy in the United States, 2000-2010

Abstract

We assessed laboratory monitoring after combination antiretroviral therapy initiation among 3678 patients in a large US multisite clinical cohort, censoring participants at last clinic visit, combination antiretroviral therapy change, or 3 years. Median days (interquartile range) to first hematologic, hepatic, renal, and lipid tests were 30 (18-53), 31 (19-56), 33 (20-59), and 350 (96-1106), respectively. At 1 year, approximately 80% received more than 2 hematologic, hepatic, and renal tests consistent with guidelines. However, only 40% received 1 or more lipid tests. Monitoring was more frequent in specific subgroups, likely reflecting better clinic attendance or clinician perception of higher susceptibility to toxicities.

Figure 1

Cumulative number of tests by laboratory category across time since combination antiretroviral therapy (cART) initiation, CFAR Network of Integrated Clinical Systems, between 2000 and 2010. * *Bold horizontal lines represent range for expected number of laboratory tests based on 2010 DHHS guidelines at 1 year and at 2 years. These ranges were calculated by taking the recommended frequency of testing and calculating the minimum and maximum number of tests recommended during the time interval. For example, the minimum for hematologic, hepatic, and renal tests at one year was calculated as one test for 8 weeks post-cART initiation and one test 6 months later for a total for a total of 2 tests. Similarly, the maximum was calculated as one test 2 weeks post-cART and then one test for each 3 month interval thereafter, totaling 4 tests within the first year.