Many people are intimidated by lab test results. Numbers and strange medical terms can seem confusing and too complicated to understand. But once you start to develop a basic grasp of what they mean, they can serve as a guide, measuring stick for progress or a map to chart your course. Understanding your lab results can also help inform the questions you ask your care provider about your health.
Laboratory tests give primary care providers invaluable assessments of a patient’s health. They can also help people living with HIV (PLWH) to understand their health status and determine what they need to do to stay healthy or to improve their health.
How lab tests help maintain HIV health
The goal of antiretroviral treatment is to decrease viral load, disrupt replication of the virus and increase CD4 cell counts to strengthen the immune system.
For PLWH, lab tests can answer a number of essential questions such as:
- Are prescribed HIV medications working?
- Are the meds causing side effects that can impact a person’s ability to live and perform basic tasks? If so, what other medications can be considered?
- Are the medications affecting key bodily functions such as those of the liver and kidneys?
- Has the virus become resistant to the current drug regimen or has the virus mutated to the point that current meds are no longer controlling HIV?
- What is the status of the immune system?
“While monitoring CD4 counts is important to doctors, the main number that matters to patients is viral load. As long as that is undetectable, the meds are working and the virus is under control,” said Justin Goforth, RN, BSN, who has 30 years’ experience providing treatment adherence, medical case management, clinical staff training and community outreach for HIV/STI prevention, education and testing. “The most important action a patient can take to keep the virus undetectable is to take meds daily. Take your meds. That’s what matters most.” It should be noted, however, that not everyone might be able to get “undetectable” despite their adherence; this does not necessarily mean that their treatment is failing or inferior.
Healthy living with HIV requires attention to other health challenges
Patients and doctors who work together as partners can produce optimal medical outcomes that result in the best life possible for the individual in care. An Individual Health Inventory in four major areas collects and shares key information to treat and look for emerging health challenges. In addition to HIV health, the other three are:
Patient history: Effective care plans know and address key events and conditions that make up a person’s unique medical history, including any risks for conditions that may arise. Lab tests answer the question, How is the patient doing now? If tests indicate attention is needed, the results can help the care provider determine what needs to be done to repair or control the medical issue.
Family medical history: The health of parents and grandparents can often play a part in a person’s health. Health conditions from one generation may sometimes be passed on to the next. Genetic health challenges may be mitigated or monitored by sharing family medical history with primary and specialty care providers. Such information helps interpret health events and detect emerging issues with lab tests. Early detection and treatment can minimize harm and make treatment easier.
Chronic conditions: The CDC reports that, “six in ten Americans live with at least one chronic disease, like heart disease and stroke, cancer, or diabetes. These and other chronic diseases are the leading causes of death and disability in America, and they are also a leading driver of health care costs.”
The likelihood of chronic conditions emerging increases with age and are often controlled or managed through daily medicines and recommended behavioral changes (such as regular sleep habits, quitting smoking, reducing alcohol consumption). Lab tests identify the need for treatment and monitor the effectiveness of medications over time.
Aging with HIV
More than 40 years into the HIV epidemic, today’s approaches to care are far more responsive to patient needs, and current medications deliver long-term viral suppression without the significant side effects that were common with earlier drugs. While much has been learned about the long-term impact of the virus and HIV medications, much still needs to be studied. HIV.gov points out, “People aging with HIV share many of the same health concerns as the general population aged 50 and older: multiple chronic diseases or conditions, the use of multiple medications, changes in physical and cognitive abilities, and increased vulnerability to stressors. In addition, while effective HIV treatment has decreased the likelihood of AIDS-defining illnesses among people aging with HIV, many HIV-associated non-AIDS conditions occur frequently in older persons with HIV, such as cardiovascular disease, diabetes, renal disease, and cancer. These conditions are likely related to a number of interacting factors, including chronic inflammation caused by HIV. Researchers are working to better understand what causes chronic inflammation, even when people are being treated with ART.
“HIV and its treatment can also have effects on the brain. Researchers estimate that between 25–50% of people [living] with HIV have HIV-associated neurocognitive disorder (HAND), a spectrum of cognitive, motor, and/or mood disorders categorized into three levels: asymptomatic, mild and HIV-associated dementia. Researchers are studying how HIV and its treatment affect the brain, including the effects on older people living with HIV.”
Treatment for PLWH over age 50—many of whom have lived with HIV for years or even decades, and now comprise more than half of all PLWH in the U.S.—represents a new frontier. Regular lab tests and physician consultations are essential to tracking bodily functions and responding promptly to emerging needs.
Understanding results of common non-HIV lab tests
The overall purpose of labs is to monitor key bodily functions to be sure each is within the medically established range recognized as consistent for good health. Reports for laboratory tests have three columns: name of the test, your test score and the “reference range,” usually the range for what is considered a “normal” test result.
A care provider reviews the test results, compares them to the established ranges, factors in the specifics and other details about the patient’s health, and, if needed, recommends a target range that is appropriate and achievable for the individual. The patient and the provider then discuss and agree upon a treatment strategy.
The goal of such conversations is to help the person living with HIV know what’s needed, why the action is necessary, what behavior changes will be the most beneficial and what timing or pace is reasonable to achieve the targeted outcomes.
Mark Fischer (he, him), a retired educator and business executive, has lived with HIV since 1986. As past co-chair of the Metropolitan Washington, D.C. Ryan White Planning Council, he has provided technical assistance to other Ryan White planning councils to strengthen their PLWH participation, and is committed to empowering communities through training and mentoring. Mark and his husband live in Washington, D.C.