Antiretroviral laboratory monitoring and implications for HIV clinical care in the era of COVID-19 and Beyond

Background In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH) to avoid unnecessary exposures despite antiretroviral guidelines recommending periodic testing The purpose of this study was to examine the clinical significance of periodic renal, liver, and lipid testing Methods We reviewed the charts of 265 people with HIV (PWH) who initiated outpatient care at HIV clinic between 1/1/16 and 12/21/18 and had at least two clinic visits Analysis included frequency distributions, descriptive statistics, one-sided binomial exact tests, and Poisson models with 95% confidence intervals (CI) Results Eighty-five percent (221) of PWH had no laboratory abnormalities while on antiretroviral therapy (ART) The most common abnormality was a glomerular filtration rate (GFR) 2X upper limit of normal (ULN), no action was taken in 52% of the cases When an action was taken, the most common action was to repeat testing (18%) After a lipid panel result, the most common actions were to calculate a 10-year cardiovascular risk score (32%) and add a statin (18%) Taking action after lipid panel results was strongly associated with age ≥ 40 (estimated rate ratio 9 1, 95% CI 3 3-25) ART was changed in seven PWH based on GFR, AST/ALT, or lipid panel results There were four individuals with poor outcomes including cerebrovascular accident, acute renal failure, end stage renal disease, congestive heart failure, myocardial infarction, and death Contributing factors were hypertension, DM, and hypercholesterolemia Conclusion Individuals < 40 years without ithout comorbidities had a low risk of having clinically significant renal and liver function abnormalities and rarely had actions taken after renal, liver, or lipid results In the era of COVID-19 and beyond, it may be prudent for in certain groups to delay or eliminate liver, renal, and lipid testing to eliminate exposure, reduce cost, and avoid patient anxiety