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Other tests

Blood pressure

Blood pressure is the force that the beating heart causes in the arteries, veins, and blood vessels that carry blood around the body. Blood pressure is measured in two parts: one when the heart is beating and pumping blood (also called systolic blood pressure), and then when it is relaxing and refilling with blood (also called diastolic blood pressure).

If you have high blood pressure, your heart has to work harder to pump blood around your body. This can increase your risk of heart disease, which can cause heart attack and stroke. Blood pressure increases as you get older, but can also increase if you are overweight or if you smoke.

Because of the association between HIV and increased rates of some risk factors for heart disease, it is important that you have your blood pressure monitored regularly. You should have your blood pressure taken when you are first diagnosed with HIV, at your routine HIV clinic visits, when you start HIV treatment, and then – once you are stable on treatment – every year.

You will often also have your weight, height, waist circumference and body mass index (BMI) measured at the same time. Working out your BMI can provide an approximate idea of how healthy your body weight is. This is calculated using your height and weight. These measurements also help calculate your risk of heart disease and other health problems.

Bone health

HIV can cause a thinning of the bones, and loss of bone density is also a possible side-effect of anti-HIV drugs. However, the most significant factors affecting bone health in people with HIV are those that affect everyone: being older; reduced hormone production (such as after menopause, for women); being underweight; or a high alcohol intake. 

You should have your risk factors for low bone density assessed when you are first diagnosed with HIV and again before you start HIV treatment. Risk assessments should be done every three years for people on HIV treatment and people aged 50 and over.

Blood tests looking at the chemistry of your blood can sometimes help indicate the health of your bones, looking at levels of calcium and phosphate, for example. You will have this checked at your regular clinic appointments.

If you are 65 or older (for a woman), or 70 or older (for a man), you will have your bone mineral density checked using a DEXA scan (see Investigations). You might be recommended to have a DEXA scan sooner if your doctor thinks you are at higher risk of bone problems, especially if you are aged over 50.

Diabetes

Diabetes is a disease where the amount of glucose (blood sugar) in the body is too high because the body cannot process it properly. Diabetes exists in two forms: Type 1, which usually occurs earlier in life; and Type 2, which usually develops as a person gets older (generally over 40 – although it can appear earlier, especially in people of Asian and African-Caribbean origin).

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, and it is linked with being overweight.

Blood tests can be used to see if you have diabetes or have an increased risk of developing it. Some of the tests and measurements done to monitor the health of your cardiovascular system (heart) can also indicate whether you might be at risk of developing diabetes.

A ‘dipstick’, a small strip dipped in a sample of your urine, can indicate if there is glucose in your urine. If this test shows that you do, you will have the level of glucose in your blood measured. This is usually done by having a blood test done in the morning before you have eaten anything.

If you do have diabetes, this condition will be managed by your GP.

Kidney tests

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. Tests will measure a number of proteins, minerals and waste products your kidneys are removing from your body.

You should have your kidney (often called ‘renal’) function checked when you are first diagnosed with HIV, when you start HIV treatment, and then once a year after that. Renal monitoring is done more often if someone becomes seriously ill.

If you are taking the anti-HIV drug tenofovir (Viread, also in the combination pills Truvada, Atripla and Eviplera), which is known to cause kidney problems in some people, you will have your kidney function checked at each of your clinic visits.

A ‘dipstick’, a small strip dipped in a sample of your urine, will monitor levels of protein in your urine. Blood tests can monitor other indicators of kidney function. The key one is the estimated glomerular filtration rate, or eGFR, which measures creatinine in your blood, but you should also have the ratio of protein to creatinine in your urine measured once a year.

Liver tests

Having a healthy liver is important for people with HIV as it plays a vital part in processing anti-HIV drugs. In addition, liver disease is a significant cause of illness and death in people with HIV. So it’s very important that you have regular blood tests to monitor the function of your liver.

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

  • Alanine aminotransferase (ALT).
  • Aspartate aminotransferase (AST).
  • Alkaline phosphatase (ALP).
  • Gamma glutamyl transferase (GGT).
  • Bilirubin.
  • Albumin.

You should have your liver function checked when you are first diagnosed with HIV, at each of your routine HIV clinic appointments and if you become ill.

Liver problems can be a side-effect of a number of anti-HIV drugs. These include the non-nucleoside reverse transcriptase inhibitor, nevirapine (Viramune and Viramune prolonged-release), some protease inhibitors and, more rarely, efavirenz (Sustiva,also in the combination pill Atripla). Atazanavir (Reyataz) can increase the amount of bilirubin in your blood. In some people, this can cause a yellowing of the skin and the whites of the eyes, which is not harmful.

A number of medicines used to treat other infections that people with HIV are vulnerable to can also cause liver problems, as can statins, used to treat high cholesterol, and drugs used to treat tuberculosis (TB).

You will have more regular liver function tests if you have recently started HIV treatment (after one month and three months), and will be monitored every two weeks for the first two months if you have started treatment with the anti-HIV drug nevirapine (Viramune).

If your liver function tests show any abnormalities, especially if they continue, your doctor will suggest you have further tests to see if you might have another health problem affecting your liver.

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 B or C, and should have regular tests after this if you’re at risk of contracting hepatitis B or C.

Your doctor is likely to monitor your liver function particularly closely if you are also infected with hepatitis B virus or hepatitis C virus. Many people with HIV only discovered that they were infected with either (or both) hepatitis B or C because they had an abnormal liver function test result and were tested for the presence of these viruses.

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

Liver function tests can give an indication if you have the rare, but very serious, side-effect lactic acidosis. This can be caused by drugs in the nucleoside reverse transcriptase inhibitor (NRTI) class. See the NAM booklet Side-effects for more information.

CD4, viral load & other tests

Published July 2012

Last reviewed July 2012

Next review July 2015

Contact NAM to find out more about the scientific research and information used to produce this booklet.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.