HIV can cause a thinning of the bones, and loss of bone density is also a possible side-effect of some anti-HIV drugs.

Blood tests can look at the chemistry of your blood and the results of the tests listed below can be used to monitor the health of your bones:

• Calcium
• Phosphate
• Total protein
• Albumin
• Globulin

Bone density will also be measured using a scan – see later in this booklet for more information on scans.

Diabetes is a disease where the amount of glucose (blood sugar) in the body is too high because the body cannot process it properly.  

Blood tests can be used to see if you have diabetes or have an increased risk of developing it. Some anti-HIV drugs have been associated with an increased risk of Type 2 diabetes; the risk is lower with the drugs most commonly used in the UK today. The risk of developing Type 2 diabetes also increases with age for everyone.

The level of glucose in your blood can be measured. Measuring levels of the enzyme amylase is also important and can also show how healthy your pancreas, the organ that produces insulin, is.

If you have diabetes, your doctor will also monitor your kidney function closely (see next section).

Having healthy kidneys is important to everyone. HIV itself can damage your kidneys, and some anti-HIV drugs can also cause side-effects that affect the kidneys. So monitoring the health of your kidneys is an important part of your HIV care.

A number of tests are used to check how your kidneys are working. These include measuring a number of minerals and waste products your kidneys should be removing from your body:

• Sodium

• Potassium

• Chloride

• Urea

• Creatinine

A sample of your urine should be checked every year to monitor levels of urinary protein.

Liver disease is an important cause of illness and death in people with HIV, so the health of your liver should be regularly monitored.

The range of tests you’ll have will check levels of enzymes in your liver. These include:

• Bilirubin

• Alanine aminotransferase (ALT)

• Alkaline phosphatase

Some viruses can cause liver disease and are common in people with HIV. Hepatitis A can cause a short illness. But infection with hepatitis B or hepatitis C (or both) can cause long-term, serious liver disease. Vaccines are available against hepatitis A and hepatitis B and it’s recommended that everyone with HIV should receive them.

You should be tested at regular intervals to see if your vaccinations against hepatitis A and B are working. You should also be tested soon after your diagnosis with HIV to see if you’ve been infected with hepatitis C, and should have regular tests after this if you’re at risk of contracting hepatitis C.

See NAM’s booklet HIV & hepatitis for more information.

If you have particular symptoms or are unwell, then your doctor might request additional tests to try and find out the cause. Some of the more common of these are described here.

On occasion you may be asked to provide a urine, stool or sputum sample. These will be looked at in the laboratory to see if there are any infections or other abnormalities.

These are all painless, non-invasive ways of seeing different parts of the body.

X-rays have a number of uses and are often used to check for broken bones or problems within the chest or abdominal cavities.

Looking at an X-ray will help your doctor diagnose a number of illnesses. Chest X-rays are quite a common procedure used to look at the heart, lungs and chest wall. They can help diagnose the cause of various symptoms, such as coughs or shortness of breath. Your doctor may ask you to have a chest X-ray if they suspect you have a chest infection or tuberculosis (TB).

Sometimes your doctor may request a scan. There are two main types of scan:

• a CT (computerised tomography) scan
• an MRI (magnetic resonance imaging) scan.

These can help diagnose cancers and illnesses affecting the head, chest, abdomen and lymph nodes. MRI scans are used to look at HIV’s effects on the brain and changes in body fat distribution. Sometimes, you may be given a liquid called a ‘contrast agent’ (either by drinking it or via an intravenous drip), that highlights specific areas of the body in the scan.

Another type of scan is a DEXA (dual X-ray absorptiometry) scan. It’s useful for diagnosing thinning bones and for looking for the fat loss that some older anti-HIV drugs can cause.

An ultrasound examination is used most often to examine the abdomen, or stomach, area. It involves having an instrument placed against the surface of the abdomen and moved around the area. It’s used to check on the development of a baby in the womb and can also be used to help diagnose problems with organs such as the liver, stomach, kidneys, pancreas and spleen.

A special type of ultrasound scan can be used to check the health of the liver. It is called a Fibroscan and involves having an instrument placed against the abdomen over the liver.

If your doctor feels they need more information to diagnose or treat a health problem you have, they may recommend you have other procedures done. Some of these can be a bit more invasive, but generally don’t involve surgical procedures or need you to stay in hospital. They are usually carried out during an outpatient appointment and you can go home afterwards.

If you are offered a sedative, you may have to wait at the hospital a bit longer before you can leave. You will be advised not to drive, nor to go back to work that day. You may need to have someone to take you home and stay with you for some hours after the procedure.

This can be used to investigate chest problems. Your doctor may suggest this if you have a cough, are short of breath, or have had an abnormal chest X-ray.

It involves the use of a bronchoscope – a flexible tube that has a light and camera on it and allows a doctor to look at your bronchial tree (breathing tubes) and lungs.

Before you have a bronchoscopy, you’ll be offered some sedation, such as valium, and have a local anaesthetic sprayed onto the back of your throat. The bronchoscope is then passed through a nostril and down into the lungs. Fluid is washed down to obtain samples that can be used to diagnose lung infections such as TB or pneumonia.

A small sample of tissue (a biopsy) may also be removed during the procedure, for examination in a laboratory.

This test can be used to investigate problems in your colon, or large intestine (bowel), such as bad diarrhoea or bleeding.

It involves the use of a colonoscope. This is a thin flexible instrument with a light and a camera on it that allows a doctor to look at the rectum and colon. It can also be used to take tissue samples (biopsies) that can be examined in a laboratory.

You may need to be on a particular diet for a day or two beforehand, or you may be asked not to eat anything for some hours. You’ll be asked to take a laxative before the procedure. The colonoscope is passed up through the anus into the rectum and into the colon. It is not painful, although some people find it uncomfortable. You will usually be given a sedative to help you relax.

An endoscope is also a tube with a light and a camera attached. It is used to look at different parts of the body. It is normally put in through an opening such as the mouth or the anus, but sometimes a small incision will be made to insert it.

The most common use for an endoscope is to do a gastroscopy, used to investigate problems with the gullet, stomach or bowel. Your doctor might recommend a gastroscopy if you often have indigestion or heartburn, vomiting, stomach pain or difficulty swallowing.

The endoscope is passed through the mouth, down the gullet and into the stomach.

It’s important not to eat or drink for some hours before this procedure as the stomach has to be empty. You will be told how long to fast for.

You will be given the choice of a sedative before the procedure, a local anaesthetic spray, or both. The procedure is generally painless but might be uncomfortable at the moment you swallow the tube.

A biopsy can help diagnose some symptoms or illnesses further if the procedures described above are not adequate. A biopsy involves having a small amount of tissue removed that is then examined in a laboratory.

Sometimes a biopsy is taken when having another investigation, for example a bronchoscopy or endoscopy. At other times it will be taken by using a hypodermic needle or it will be necessary to have a small surgical procedure after having a local anaesthetic.

Biopsies can be done on a wide range of organs, including the skin, the liver, kidneys, bone marrow, the intestines, the rectum and the cervix.