Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond.

York, Lawrence; Fisher, Julia M; Malladi, Lakshmeeramya; August, Jessica A; Ellis, Kristen E; Marquez, Jose L; Kaveti, Ashwini; Khachatryan, Marine; Paz, Marissa K; Adams, Matthew D; Bedrick, Edward J; Fantry, Lori E

BACKGROUND In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH). The purpose of this study was to examine the clinical significance of renal, liver, and lipid testing. METHODS We reviewed the charts of 261 PWH who initiated care at an academic HIV clinic between 1/1/16 and 12/21/18. Analysis included one-sided binomial exact tests and multiple linear, Poisson, and Beta regression models. RESULTS The most common abnormality was a glomerular filtration rate (GFR) < 60 ml/min (10%). Age < 40 years [estimated relative rate (rr) 0.019, CI 0.003-0.14], cobicistat (rr 0.178, 95% CI 0.084-0.378), and tenofovir alafenamide were associated with a decreased risk of GFR < 60 ml/min. An increased AST or ALT ≥ 2X upper limit of normal (ULN) was found in 5% and 3%, respectively. Hepatitis C and use of darunavir and lopinavir were associated with increased AST or ALT. When a GFR was < 60 ml/min or an AST or ALT was ≥ 2X ULN, no action was taken in 53% of cases. In 18% of cases the only intervention was repeat testing. The most common interventions after lipid results were calculation of a 10-year cardiovascular risk score (31%) and addition of a statin (18%). Taking action after lipid results was strongly associated with age ≥ 40 (rr 0.37, 95% CI 3.0-18.3). CONCLUSIONS Young PWH without hepatitis C rarely have renal, liver, or lipid test results that alter clinical care. Decreased testing should be considered.