Core Competencies: HIV/AIDS: Understanding Labs
UNDERSTANDING LAB VALUES*
ABOUT THIS ACTIVITY
Time: 45 minutes
Objectives: By the end of this session,
participants will be able to:
• Understand the importance of having
regular lab work done by knowing
what specific HIV test results mean
such as viral load, CD4, resistance
tests.
• Understand what CD4 percentage
and T-cell ratio indicate and review
other significant subset tests.
• Understand what CBC and blood
chemistry tests are performed and
why they are checked.
• Understand the importance of having
cholesterol, triglycerides, blood
pressure and glucose levels tested
and how they may relate to HIV
treatment adherence and care.
Training Methods: Large Group
Discussion, Lecture
In This Activity You Will…
• Share definitions with group
(25 minutes).
• Engage group by asking
questions about their lab values
(10 minutes).
• Lead a group discussion to
summarize (10 minutes).
(continued next page)
Building Blocks to Peer Success
Instructions
Follow Talking Points (Powerpoint Slides.)
Slide 1: Making Sense of Lab Values
If you are living with HIV, lab tests are one of the most important
ways you and your healthcare provider can monitor your health.

Slide 2: Making Sense of Lab Values
Doctors use lab tests to monitor your health. Lab tests:
• Detect the presence of disease-causing organisms (e.g. bacteria,
viruses, parasites) that may be related to HIV
• Tell when to treat, how to treat, and if treatment is working
• Identify the development of side effects related to treatment
• Detect other infections and problems associated with HIV
infection
Slide 3: Step 1 - Lab Basics
Confirm your personal information:
• Name
• Age
• Gender
• Social security number
• Ask about anything you do not understand.
Slide 4: Step 2 - Lab Timeline
So what are the baseline lab tests your doctor will want you to
take? These are the most common, but they are not the only tests
your doctor may want you to take.
Baseline Tests:
• A complete blood count or CBC
• A CD4 T-cell count and percentage
• A drug resistance test (this may not be required by your physician)
• A viral load test
• A chemistry panel
* This module comes from the Missouri People to People Training Manual, 2008.
1
 UNDERSTANDING LAB VALUES

ABOUT THIS ACTIVITY (CONT.) There are also a number of other tests that your doctor will
probably order as a baseline measurement—to be able to keep
Materials: track if things change. As time goes on, these other tests will be
ordered periodically, or if your doctor suspects a problem.
• Laptop
• Projector with screen or blank white We’ll discuss each of these tests in more detail in a moment.
wall
• Markers
Slide 5-6: Periodic Labs
• Participant booklet to follow lesson
and power point A fter the baseline lab tests have been taken, your doctor will ask
you to take them again periodically. Now what does that mean?
To begin, generally every quarter, or about every 3 months
Preparation: None
throughout your treatment, your doctor may want to perform
the lab tests listed here:
• Viral load test
• CBC
• CD4 T-cell count and percentage
• A lipid profile for cholesterol and triglycerides
• A fasting blood sugar test for diabetes
Your doctor may also want you to take these additional tests:
• Liver function tests, because many HIV/AIDS meds are
processed by the liver
• Kidney function test, because many HIV/AIDS meds are
excreted by the kidneys
• Hepatitis A, B, and C
• HIV resistance (if your therapy fails to lower the viral load or
achieves only suboptimal suppression)
• Toxoplasma antibody IgG (which tests for a blood-borne illness
that people can get from cats)
• CMV IgG
Beyond blood tests, these additional screenings may be done:
• Pap smear, including a vaginal pap smear for women, and an anal
pap smear for men and women
• Full sexually transmitted disease or STD screening
• Chest X-ray
• PPD skin test for tuberculosis

Building Blocks to Peer Success 2

 UNDERSTANDING LAB VALUES
Your doctor may also want to make sure the
following vaccines are up-to-date:
• Pneumococcal vaccine (if not given in the last 5
years)
• Tetanus/diphtheria toxoid (if not given in the last
10 years)
• Hepatitis A & B vaccines
• Flu vaccine
Slide 7: Labs (3-4 months)
• CBC values
• Red blood cell count – Cells that carry oxygen
White blood cell count – (different types) make up
the immune system-fight infection
• CD4
• One of the white blood cells (Lymphocyte) that tell
other white blood cells to attack HIV
• Drug resistance testing
Genotype - HIV infection within 2 years of
diagnosis – resistance profile
• Viral load
• Chemistry panel
Liver function
Kidney function
Lipid profile
Fasting – 1 yearly
Blood sugar
Slide 8: Lab Values
Th
 e CBC or complete blood count lab value tests is
a report of the red blood cell count.
• One of the most commonly used blood tests
• Examines blood components including red and
white blood cells
• Blood components are made in bone marrow, which • Usually does not vary as much as the actual CD4
can be affected by HIV and antiretroviral agents
Building Blocks to Peer Success
Th
 e CBC is a very important gauge of your overall
health, so it is one of the most commonly used blood
tests for monitoring HIV and AIDS. The CBC
examines the components of your blood, including
your red and white blood cells. Why are these lab values
important? For two reasons: First, because these cells are
produced in the marrow of your bones. Second, because
your bone marrow can be affected by HIV and AIDS
and antiretroviral agents.
Slide 9: Lymphocyte tests
• CD4 is a WBC called Lymphocyte
Counts the number of CD4 T-cells
• Normal CD4 count (helper T-cell count)
600-1500 cells/mm3 is normal for healthy adults
Children’s counts are much higher
Less than 200 cause increased risk of opportunistic
infections. The lower the CD4 drops, the more risk
• CD4%
More consistency than a single measurement
Less than 30% means some level of immunodeficiency
(weakened immune system
Slide 10: What about ups and downs?
CD4 T-cell counts can vary according to:
• Type of test
• Time of day
• Current or recent infection
• Stress
• Fatigue
Slide 11: CD4 Percentage
• C D4 accounts for 30%-60% of all the immune cells
measurement
• Some providers might consider starting antiviral therapy
when the CD4% is <15-17 even if CD4 remains > 350
copies
3
 UNDERSTANDING LAB VALUES
TRAINING TIP
Things to stress:
• If you are living with HIV, as you
can see there are numerous lab
tests usually done quarterly that
can be confusing, mind boggling
thereby leaving HIV+ people’s heads
spinning.
• It is important to remember that your
healthcare provider often welcomes
the opportunity for you to take an
active role in your care by asking
questions about your lab results to
understand what they mean and
more importantly what you can do to
make a lifestyle change to make a
difference in some of those results.
Building Blocks to Peer Success
Slides 12-13: Viral load
• O ne of the most important tests you will take about every 3
months
• Often considered the critical marker in the management of HIV
and AIDS
• Measures the amount of HIV in your blood
Slide 14: Chemistry Panel
This is an example of a chemistry panel. The chemistry panel is
probably the most substantial portion of your lab results, because
it provides a lot of information about how your body is doing.
Specifically, the chemistry panel indicates how your major organs
are working. The chemistry panel provides information on your
heart, liver, kidneys, muscles, and bones.
Slide 15: Liver Function Tests
• M ost HIV medications are processed through the liver
• Conditions that affect your liver can also affect your meds
• Tests used to monitor liver function are:
ALT, also known as SGPT
AST, also known as SGOT
Bilirubin
Alkaline phosphatase
Slide 16: Kidney Function Tests
• H IV can cause kidney damage So can diabetes and cardiovascular
disease
• Many HIV meds are cleared from the body by the kidneys
• In people with reduced kidney function, the doses of some HIV
meds may need to be adjusted
• Tests for kidney function include:
Blood Urea Nitrogen (BUN)
Creatinine
4
 UNDERSTANDING LAB VALUES

Slides Lipids 17 - 19
• HIV, and some HIV meds, can increase lipid levels
• People with high levels of LDL cholesterol and
triglycerides are at a greater risk for:
Cardiovascular (heart) disease
Heart attack
Stroke
• Factors that can increase the risk of elevated lipids
include:
Family history of cardiovascular disease
High blood pressure
Smoking
• Things you can do to decrease the risk include:
Eat healthy
Exercise
Quit smoking
Appropriate lipid-lowering drugs
• Cholesterol - Types of fat in the blood
Triglycerides - <150 (related to amount of sugar
intake)
Cholesterol - <200
LDL (lethal) – bad cholesterol <100
HDL (healthy) – good cholesterol >60
• A
 bnormal ranges put one at risk for cardiovascular
events and pancreatitis Many HIV medications affect
cholesterol
Slide 20: Blood sugar levels
G
 lucose is sugar and is broken down in your body to
provide your cells with energy. High blood sugar may
be a sign of diabetes, which can lead to a variety of
cardiovascular and other health problems. High blood
sugar levels eventually cause damage to your eyes,
nerves, kidneys, and heart. Some HIV medications,
including protease inhibitors, can increase blood sugar
levels.
Summary
• U nderstanding your labs enables you to play an active
and proactive role in your health care
• Use your new knowledge of lab tests and lab values to
be a partner with your doctor
• Live smarter, healthier, and happier by being in control

* This module is part of the online toolkit Building Blocks to Peer Success. For more
information, visit http://www.hdwg.org/peer_center/training_toolkit.
This module comes from the Missouri People to People Training Manual, 2008.
Building Blocks to Peer Success 5
 UNDERSTANDING LAB VALUES
SESSION HANDOUT # 1 of 1

Making
Making Sense
Sense of
of Lab
Lab Values
Values
•• Doctors
DoctorsUse
UseLab
LabTests
Teststo
toMonitor
MonitorYour
YourHealth
Health
•• Lab
Labtests:
tests:
–– Detect
Detectthe
thepresence
presenceof
ofdisease-causing
disease-causingorganisms
organisms
Making
Making Sense
Sense of
of Lab
Lab Values
Values •• (e.g.
(e.g.bacteria,
bacteria,viruses,
viruses,parasites)
parasites)that
thatmay
maybe
berelated
relatedtotoHIV
HIV
–– Tell
Tellwhen
whento totreat,
treat,how
howtototreat,
treat,and
andififtreatment
treatmentisis
Understanding working
UnderstandingLabs
Labsand
and working
–– Identify
Identify the development of side effectsrelated
the development of side effects relatedto
to
Why They Are Important
Why They Are Important treatment
treatment
–– Detect
Detect other infections and problems associatedwith
other infections and problems associated withHIV
HIV
infection
infection

Step
Step 2:
2: lab
lab timeline
timeline
Step
Step 1:
1: lab
lab basics
basics Your
YourTreatment
TreatmentTimeline
Timeline
Confirm
Confirmyour
yourpersonal
personalinformation:
information: Tests
Testsyou
youmay
maytake
takeatatbaseline
baseline
–Name
–Name
–Age
–Age Baseline
Baselinetests
tests Other
Othertests
tests(not
(notusing
usingblood):
blood):
 Complete blood count (CBC)  STD screening
–Gender
–Gender  Complete blood count (CBC)
 CD4 T-cell count and %
 STD screening
 Pap smear (women/men)
 CD4 T-cell count and %  Pap smear (women/men)
–Social
–Socialsecurity
securitynumber
number
 Drug resistance testing
 Drug resistance testing
 Chest X-ray
 Chest X-ray
 HIV viral load test  Tuberculosis test
 HIV viral load test  Tuberculosis test
Ask
Askabout
aboutanything
anythingyou
youdo
donot
notunderstand
understand  Chemistry panel
 Chemistry panel
 Liver function tests
 Liver function tests
 Kidney function tests
 Kidney function tests
 Hepatitis A, B, and C
 Hepatitis A, B, and C
 Toxoplasma IgG
 Toxoplasma IgG
 Cytomegalovirus
 Cytomegalovirus

Periodic
Periodic labs
labs DEFINITIONS
DEFINITIONS
Periodic
Periodiclabs
labs
•• Viral
Viralload
loadtest
testshows
showsthetheamount
amountof ofHIV
HIVRNARNAin inyour
your
 Viral load test
 Viral load test blood
bloodand andtells
tellsyou
youhow
howactive
activethethevirus
virusisisin
inyour
your
 CBC (complete blood count)
 CBC (complete blood count)
 CD4 T-cell count and %
body.
body. Higher
Highernumbers
numbersmean meanyou youhave
have more
more virus
virus in
in
 CD4 T-cell count and %
 Lipid profile and blood sugar (fasting)
 Lipid profile and blood sugar (fasting)
your
yourbody.
body.
•• Opportunistic
Opportunisticinfections
infectionsare
are illnesses
illnessescaused
causedby by
Occasional
Occasionaltests/vaccines
tests/vaccines different
differentorganisms,
organisms, somesomeofofwhich
whichdodonot
notusually
usually
 Liver function tests
 Liver function tests
 Kidney function te sts
cause
cause disease
disease ininpeople
people with
withaanormal
normalimmune
immune
 Kidney function te sts
 Hepatitis A, B, and C
 Hepatitis A, B, and C
system.
system. Opportunistic
Opportunisticinfections
infectionsof ofthe
thelungs,
lungs,brain,
brain,
 HIV resistance
 HIV resistance eyes,
eyes,andandother
otherorgans
organscan
candevelop
developin inpeople
people with
with
 Toxoplasma IgG test
 Toxoplasma IgG test
 Cytomegalovirus
 Cytomegalovirus
HIV
HIVinfection.
infection.

Building Blocks to Peer Success 6

 UNDERSTANDING LAB VALUES
SESSION HANDOUT # 1 of 1(cont.)

Labs
Labs (3-4
(3-4 months)
months) Lab
Lab values
values
•• CBC
CBCvalues •• Viral
values
–– Red
Viralload
load
Redblood
bloodcell
cellcount
count
•• Cells
Cellsthat
thatcarry
carryoxygen
oxygen
•• Chemistry
Chemistrypanel
panel
–– White
Whiteblood
bloodcell
cellcount –– Liver
count Liverfunction
function
•• (different
(differenttypes)
types)make
makeup upthe
the
immune –– Kidney
Kidneyfunction
function
immunesystem-fight
system-fightinfection
infection
•• CD4
CD4 –– Lipid
Lipidprofile
profile
–– One
Oneofofthe
thewhite
whiteblood
bloodcells
cells •• Fasting
Fasting––11yearly
yearly
(Lymphocyte)
(Lymphocyte)that thattell
tellother
otherwhite
white •• Blood
blood
bloodcells
cellstotoattack
attackHIV
HIV Bloodsugar
sugar
•• Drug
Drugresistance
resistancetesting
testing One
Oneofofthe
themost
mostcommonly
commonlyused
usedblood
bloodtests
tests
Genotype(done
–– Genotype (doneasasneeded)
needed)
Examines
•• HIV
HIVinfection
infectionwithin
within22years
yearsofof Examinesblood
bloodcomponents
componentsincluding
includingred
redand
and
diagnosis
diagnosis–resistance
–resistanceprofile
profile white
whiteblood
bloodcells
cells
Blood
Bloodcomponents
componentsare
aremade
madeininbone
bonemarrow,
marrow,
which
whichcan
canbe
be
affected
affectedby
byHIV/AIDS
HIV/AIDSand
andantiretroviral
antiretroviralagents
agents

Lymphocyte
Lymphocyte tests
tests What
What about
about ups
ups and
and downs?
downs?
•• CD4
CD4isisaaWBC
WBCcalled
calledLymphocyte
Lymphocyte •• CD4
CD4T-cell
T-cellcounts
countscan
canvary
varyaccording
accordingto:
to:
–– Counts
Countsthe
thenumber
numberofofCD4
CD4T-cells
T-cells –– Type
Typeofoftest
test
–– Time
Timeofofday
day
•• Normal
NormalCD4
CD4count
count(helper
(helperT-cell
T-cellcount)
count) –– Current
Currentororrecent
recent
–– 600-1500
600-1500cells/mm
3
cells/mm 3isisnormal
normalfor
forhealthy
healthyadults
adults infection
infection
–– Children’s
Children’scounts
countsare
aremuch
muchhigher
higher –– Stress
Stress
•• Less
Lessthan
than200
200cause
causeincreased
increasedrisk
riskof
ofopportunistic
opportunisticinfections.
infections. Lower
Lowerthe
the
CD4 –– Fatigue
Fatigue
CD4drops,
drops,the
themore
morerisk
risk
•• CD4%
CD4%
–– More
Moreconsistency
consistencythan
thanaasingle
singlemeasurement
measurement
–– Less
Lessthan
than30%
30%means
meanssome
somelevel
levelofofimmunodeficiency
immunodeficiency(weakened
(weakened
immune system)
immune system)

CD4
CD4 (%)
(%) Percentage
Percentage Viral
Viral load
load
•• CD4
CD4accounts
accountsfor
for30%-60%
30%-60%ofofall
allthe
theimmune
immunecells
cells •• One
Oneof
ofthe
the most
most important
importanttests
testsyou
youwill
willtake
take
•• Usually
Usuallydoes
doesnot
notvary
varyas
asmuch
muchasasthetheactual
actualCD4
CD4 about
aboutevery
every33months
months
measurement
measurement
•• Some
Someproviders
providersmight
mightconsider
considerstarting
startingantiretroviral
antiretroviraltherapy
therapy •• Often
Oftenconsidered
consideredthe
thecritical
criticalmarker
markerin
inthe
the
when
whenthe
theCD4%
CD4%isis<15-17
<15-17even
evenififCD4
CD4remains
remains>>350
350copies
copies management
management ofofHIV
HIVand
andAIDS
AIDS

•• Measures
Measuresthe
the amount
amountof
ofHIV
HIVin
inyour
yourblood
blood

Building Blocks to Peer Success 7

 UNDERSTANDING LAB VALUES
SESSION HANDOUT # 1 of 1(cont.)

Viral
Viral load
load Chemistry
Chemistry panel
panel

Liver
Liver function
function tests
tests Kidney
Kidney function
function test
test
•• HIV
HIVcan
cancause
causekidney
kidneydamage
damage
•• Most
MostHIV
HIVmedications
medicationsare
areprocessed
processed –– So
Socan
candiabetes
diabetesand
andcardiovascular
cardiovasculardisease
through
throughthe
theliver
liver disease
•• Conditions •• Many
ManyHIVHIVmeds
medsare
arecleared
clearedfrom
fromthe
thebody
bodyby
bythe
the
Conditionsthat
thataffect
affectyour
yourliver
livercan
can
also
alsoaffect
affectyour
yourmeds
meds kidneys
kidneys
•• Tests
Testsused
usedtotomonitor
monitorliver
liver •• InInpeople
peoplewith
withreduced
reducedkidney
kidneyfunction,
function,the
thedoses
dosesof
of
function
functionare:
are: some
someHIV
HIVmeds
medsmay
mayneed
needto tobe
beadjusted
adjusted
–– ALT,
ALT,also
alsoknown
knownas
asSGPT •• Tests
–– AST,
SGPT Testsfor
forkidney
kidneyfunction
functioninclude:
include:
AST,also
alsoknown
knownas
asSGOT
SGOT –– Blood
–– Bilirubin BloodUrea
UreaNitrogen
Nitrogen(BUN)
(BUN)
Bilirubin –– Creatinine
–– Alkaline Creatinine
Alkalinephosphatase
phosphatase

Lipid
Lipid panel
panel Lipid
Lipid tests
tests
•• HIV,
HIV,and
andsome
someHIV
HIVmeds,
meds,can canincrease
increaselipid
lipidlevels
levels
•• People
Peoplewith
withhigh
highlevels
levelsofofLDL
LDLcholesterol
cholesteroland
andtriglycerides
triglycerides
are at a greater risk for:
are at a greater risk for:
–– Cardiovascular
Cardiovascular(heart)
(heart)disease
disease
–– Heart
Heartattack
attack
–– Stroke
Stroke
•• Factors
Factorsthat
thatcan
canincrease
increasethe
therisk
riskof
ofelevated
elevatedlipids
lipidsinclude:
include:
–– Family
Familyhistory
historyofofcardiovascular
cardiovasculardisease
disease
–– High
Highblood
bloodpressure
pressure
–– Smoking
Smoking
•• Things
Thingsyou
youcan
cando
doto
todecrease
decreasethe
the
risk
riskinclude:
include:
–– Eat
Eathealthy
healthy
–– Exercise
Exercise
–– Quit
Quitsmoking
smoking
–– Appropriate
Appropriatelipid-lowering
lipid-loweringdrugs
drugs

Building Blocks to Peer Success 8

 UNDERSTANDING LAB VALUES
SESSION HANDOUT # 1 of 1(cont.)

Lipids
Lipids Blood
Blood sugar
sugar levels
levels
•• Cholesterol
Cholesterol--Types
Typesof
offat
fatininthe
theblood
blood
–– Triglycerides
Triglycerides--<150
<150(related
(relatedto
toamount
amountofofsugar
sugarintake)
intake)
–– Cholesterol
Cholesterol--<200
<200
•• LDL
LDL(lethal)
(lethal)––bad
badcholesterol
cholesterol<100
<100
•• HDL
HDL(healthy)
(healthy)––good
goodcholesterol
cholesterol>60
>60
–– Abnormal
Abnormalranges
rangesput
putone
oneatatrisk
riskfor
forcardiovascular
cardiovascularevents
eventsand
and
pancreatitis
pancreatitis Many
ManyHIV
HIVmedications
medicationseffect
effectcholesterol
cholesterol

In
In closing
closing
•• Understanding
Understandingyouryourlabs
labsenables
enablesyou
youto
toplay
playan
anactive
activeand
and •• Activity
Activity
proactive
proactiverole
roleininyour
yourhealth
healthcare
care
“Test
“Test Tubes”
Tubes”
•• Use
Useyour
yournew
newknowledge
knowledgeofoflab
labtests
testsand
andlab
labvalues
valuesto
tobe
beaa
partner
partnerwith
withyour
yourdoctor
doctor

•• Live
Livesmarter,
smarter,healthier
healthierand
andhappier
happierby
bybeing
beinginincontrol
control

Building Blocks to Peer Success 9