Study: Delay lab tests in low-risk HIV patients to minimize COVID-19 exposure
Despite guidelines recommending periodic laboratory testing in patients with HIV on ART, it may be beneficial to delay liver, renal and lipid testing in low-risk patients to minimize exposure to COVID-19, new data suggest.
In the era of the COVID-19 pandemic, physicians have had to reconsider how and for whom testing is done, particularly in people living with HIV who, as a result of a myriad of risk factors, may be predisposed to having severe disease should they acquire COVID-19, Lawrence D. York, PharmD, from the University of Arizona Health Sciences, said during a virtual poster presentation at IDWeek.
“As a result, we wanted to look at the clinical significance of the periodic renal, liver and lipid testing that we were doing based on guidelines. Furthermore, we wanted to look at outcomes or actions taken based on those values that we’re collecting,” York said.
Consequently, York and colleagues reviewed charts from 261 people with HIV who initiated care at their outpatient academic HIV clinic between Jan. 1, 2016, and Dec. 21, 2018. Patients had to have had at least two clinic visits and at least one set of comprehensive metabolic panel values at least 7 days after initiating ART. The analysis included 946 comprehensive metabolic panels and 270 lipid panels.
In terms of demographics, York noted that most patients were Caucasian, identified as men who have sex with men and had CD4 cell counts greater than 500 cells/µL.
The researchers found that 85% of people with HIV had no lab abnormalities while on ART. Among those who did, the most common abnormality was diminished glomerular filtration rate (GFR), which was defined as less than 60 mL/min and ultimately occurred in 10% of the study population. Upon further analysis, the researchers also saw an association between diabetes and increased risk for having diminished GFR and an association between age younger than 40 years and a decreased risk for having diminished GFR.
“When a GFR was below that value or we had an elevated AST [aspartate aminotransferase] or ALT [alanine aminotransferase], which we defined as greater than two times the upper limit of normal, it turned out that no action was taken in 53% of those cases,” York said.
When action was taken, York said the most common action was repeat testing, occurring in 18% of those cases.
After a lipid panel result, the most common actions observed were calculation of a 10-year cardiovascular risk score, which occurred in 32% of cases. Additionally, based on the results, a statin may have been added, which occurred in 18% of cases. Age younger than 40 years was also strongly associated with taking action after a lipid panel result.
The researchers also noted that ART regimens were changed in seven patients based on the results of GFR, ALT, AST or lipid panel results.
Four individuals in the study experienced poor outcomes, such as cerebrovascular accident, acute renal failure, end-stage renal disease, congestive heart failure, myocardial infarction and death. In these cases, other contributing factors included diabetes, hypertension and hypercholesterolemia.
“In conclusion, we identified that individuals less than 40 years without comorbidities obviously seem to have a low risk for having clinically significant renal and liver function abnormalities and very rarely did have an action have to be taken after the result of a renal, liver or lipid panel,” York said. “Therefore, we propose that in the era of COVID-19, it might be prudent to delay or eliminate some of these tests in individuals who are otherwise at little or no risk.”