HIV Lab Tests and Results

HIV Lab Tests and Why They Are Important

Before you start treatment with HIV medicine (called antiretroviral therapy or ART), your health care provider will order several baseline lab tests. You may start treatment or be referred for treatment before the test results are in.

Your lab test results, along with your physical exam and other information you provide, will help you and your provider work together to manage your HIV care.

Your health care provider will periodically repeat some of these lab tests as part of your ongoing HIV care to see how well your HIV medicine is working so that you can get the virus under control, protect your health, improve your immune status and prevent other infections called opportunistic infections, and prevent transmitting the virus to others.

Viral Load Test

One important test is your HIV viral load test. It’s a lab test that measures of the amount of HIV in your blood. When your viral load is high, you have more HIV in your body. This means your immune system is not fighting HIV very well. HIV viral load tests are used to monitor the progress of your HIV infection and how well your treatment is working. Once you start HIV medicine, you want your viral load to decrease and stay low.

Why it’s important: Taking HIV medicine can make your viral load very low--so low that the virus can’t be detected by a viral load test. This is known as having an undetectable viral load. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long, healthy lives and will not transmit HIV to their HIV-negative partners through sex. This is often referred to as “undetectable=untransmittable” or U=U.

An undetectable viral load does not mean there is no HIV in your body. It means that the amount of HIV in your blood is too low to be measured in a standard viral load test. HIV is still in your body and will rebound to detectable if you stop taking HIV medicine.

CD4 Cell Count

A CD4 cell count measures how many CD4 cells are in your blood. CD4 cells are infection-fighting cells in your immune system. If too many CD4 cells are lost, your immune system will have trouble fighting off infections. A CD4 cell count is a good measure of how well your immune system is working and your risk of opportunistic infections. You want your CD4 cell count to be high. The CD4 count of an adult/adolescent who is generally in good health ranges from 500 to 1,200 cells/mm3. In contrast, if a person has a CD4 count of fewer than 200/mm3, they are considered to have progressed to stage 3 (AIDS), the most advanced stage of HIV.

Why it’s important: A CD4 cell count is a good measure of how well your immune system is working and your risk of opportunistic infections. Treatment with HIV medicine is recommended for everyone with HIV, no matter how high or low their CD4 count is.

Once you’ve started HIV treatment, CD4 cell count and viral load tests are used to monitor whether your HIV medicines are working effectively to control your HIV. If a test indicates your medicines aren’t working, your doctor can prescribe different ones that may work better.

Other Important Lab Tests

There are other lab tests that will help your health care provider get important information about your health and work with you to choose the right HIV medications for you.

• Blood Chemistry Tests: This group of tests measures several different chemicals in your blood to help monitor the health of your organs, especially your heart, liver, and kidneys. Health care providers use these tests to look for some complications caused by HIV infection itself and for side effects caused by HIV medicines.
• CD4 Percentage: This is a measurement of how many of your white blood cells are actually CD4 cells. CD4 cell counts are typically used to assess a person’s immune function, but a CD4 percentage can also be used. A CD4 percentage is less likely to vary in between blood tests than CD4 counts, which can vary from month to month or day to day.
• Complete Blood Count (CBC): This test measures the concentration of red blood cells, white blood cells, and platelets in a sample of your blood. A CBC is one of the most commonly ordered blood tests. It helps your health care provider keep track of your overall health and spot infections or other potential medical problems.
• Drug Resistance Tests: HIV can change form, making it resistant to some HIV medicines. A drug resistance test helps your health care provider identify which, if any, HIV medicines will not be effective against the strain of HIV you have and choose which HIV medicines are most likely to work for you.
• Fasting Glucose (Blood Sugar) Test: This test measures your blood sugar levels. Some HIV medications can affect blood sugar levels, potentially leading to complications like diabetes. It’s important to get a glucose test when you start HIV treatment to help guide the choice of HIV medications and then to get repeat tests to monitor possible increases in your blood glucose. (Read more about diabetes and people living with HIV.)
• Fasting Lipid Panel (Cholesterol and Triglycerides): Lipids are fat or fat-like substances found in the blood and body tissues. These tests measure your lipid levels, including cholesterol and triglycerides. That’s important because some HIV medications can affect your cholesterol levels and the way your body processes and stores fat. High lipids can make you prone to other medical problems, including heart problems. It’s important to know what your lipids are when you start treatment to help guide the choice of medications and to treat high lipids to avoid other serious health problems.
• Hepatitis A, B, and C Tests: Some people with HIV also have viral hepatitis. These blood tests check for current or past infection with Hepatitis A, B, or C. Checking you for hepatitis A, B, and C infection can help your provider to determine if you need to be treated, or if you are a candidate for one of the existing hepatitis A or B vaccines. (Read more about how hepatitis affects people living with HIV.)
• PAP Test (Cervical and Anal): A cervical Pap test (or Pap smear) looks for cancers and precancers in a woman’s cervix—the lower part of a woman’s uterus (womb), which opens into the vagina. The test involves using a swab to take cell samples directly from the cervix. An anal Pap test can be done on a male or female; it involves a swab to take a cell sample from the anal canal. For women living with HIV, abnormal cell growth in the cervix is common, and abnormal anal cells are common for both men and women with HIV. These abnormal cells may become cancerous if they aren’t treated.
• Pregnancy Test: This test shows whether a woman is pregnant or not. If you have HIV and you are pregnant, you can greatly lower your risk of passing HIV to your baby and protect your own health by taking ART during pregnancy, labor, and delivery.
• Sexually Transmitted Disease (STD) Screening: These screening tests check for syphilis, gonorrhea and chlamydia. STDs can cause serious health problems if not treated. Having an STD also can increase your risk of transmitting HIV to others.

There are other tests your health care provider may want to do in addition to the ones listed above.

Frequency and Timing of Testing

After you start HIV treatment, not all lab tests will be conducted at every medical visit. Some will occur every few visits. Others will depend on whether you are stable on HIV treatment and doing well. View this chart about the timing of various tests and talk to your provider about what is recommended for you.