/$%25$725< 5(48,6,7,21
25'(5,1* 3+<6,&,$1 $''5(66 063 35$&7,7,21(5 180%(5
)RU ORFDWLRQV DQG KRXUV RI RSHUDWLRQ SOHDVH YLVLW ZZZ EFELR FRP
%& %LRPHGLFDO /DERUDWRULHV /WG LV WKH FRPPXQLW\ ODERUDWRU\ SUDFWLFH RI 'U & - &RDG\ $VVRFLDWHV 7KLV UHTXLVLWLRQ IRUP ZKHQ FRPSOHWHG IRU WHVWV SHUIRUPHG E\ %& %LRPHGLFDO /DERUDWRULHV /WG LV D PHGLFDO UHIHUUDO WR 'U & - &RDG\ $VVRFLDWHV
<HOORZ KLJKOLJKWHG Ã&#x20AC;HOGV PXVW EH FRPSOHWHG WR DYRLG GHOD\V LQ VSHFLPHQ FROOHFWLRQ DQG SDWLHQW SURFHVVLQJ %LOO WR
063
,&%&
)RU WHVWV LQGLFDWHG ZLWK D EOXH WLFN ER[ FRQVXOW SURYLQFLDO JXLGHOLQHV DQG SURWRFROV ZZZ %&*XLGHOLQHV FD /2&80 )25 3+<6,&,$1
:RUN6DIH%& 3$7,(17 27+(5
3+1 180%(5
,&%& :RUN6DIH%& 5&03 180%(5
6851$0( 2) 3$7,(17
),567 1$0( 2) 3$7,(17
063 35$&7,7,21(5 180%(5
'2%
<<<<
00
6(;
''
0
)
7(/(3+21( 180%(5 2) 3$7,(17
3UHJQDQW"
<(6
12
)DVWLQJ"
,I WKLV LV D 67$7 RUGHU SOHDVH SURYLGH FRQWDFW WHOHSKRQH QXPEHU K SF
&RS\ WR 3K\VLFLDQ 063 3UDFWLWLRQHU 1XPEHU
&+$57 180%(5
&,7< 72:1
$''5(66 2) 3$7,(17 ',$*126,6
3529,1&(
&855(17 0(',&$7,216 '$7( $1' 7,0( 2) /$67 '26(
1st positive HIV test +(0$72/2*<
85,1( 7(676
&+(0,675< *OXFRVH IDVWLQJ VHH UHYHUVH IRU SDWLHQW LQVWUXFWLRQV
8ULQH FXOWXUH OLVW FXUUHQW DQWLELRWLFV
+HPDWRORJ\ SUR¿OH 37 ,15 )HUULWLQ TXHU\ LURQ GH¿FLHQF\
,URQ WUDQVIHUULQ VDWXUDWLRQ KHPRFKURPDWRVLV VFUHHQ
`
*OXFRVH BBBBBBBBBBB KRXUV SRVW PHDO
2Q ZDUIDULQ" 6SHFLDO FDVH LI RUGHUHG WRJHWKHU
*77 JHVWDWLRQDO GLDEHWHV VFUHHQ J ORDG KRXU SRVW ORDG
0DFURVFRSLF Â&#x2C6; PLFURVFRSLF LI GLSVWLFN SRVLWLYH
*77 JHVWDWLRQDO GLDEHWHV FRQ¿UPDWLRQ J ORDG IDVWLQJ
0DFURVFRSLF Â&#x2C6; XULQH FXOWXUH LI S\XULD RU QLWULWH SUHVHQW
KRXU KRXU WHVW
0DFURVFRSLF GLSVWLFN 0LFURVFRSLF
*77 QRQ SUHJQDQW J ORDG KRXU WHVW
6SHFLDO FDVH LI RUGHUHG WRJHWKHU
+HPRJORELQ $ F
3UHJQDQF\ WHVW
$OEXPLQ FUHDWLQLQH UDWLR $&5
0,&52%,2/2*< ODEHO DOO VSHFLPHQV ZLWK SDWLHQW¶V ¿UVW ODVW QDPH '2% DQG RU 3+1 VLWH 5287,1( &8/785(
6SXWXP
6XSHU¿FLDO :RXQG
'HHS :RXQG
9 RQH ER[ RQO\ )RU RWKHU OLSLG LQYHVWLJDWLRQV SOHDVH RUGHU
VSHFL¿F WHVWV EHORZ DQG SURYLGH GLDJQRVLV
$FXWH YLUDO KHSDWLWLV XQGH¿QHG HWLRORJ\
/LVW FXUUHQW DQWLELRWLFV 7KURDW
/,3,'6
+(3$7,7,6 6(52/2*<
%ORRG
8ULQH
+HSDWLWLV $ DQWL +$9 ,J0
+HSDWLWLV % +%V$J DQWL +%V
+HSDWLWLV & DQWL +&9
%DVHOLQH FDUGLRYDVFXODU ULVN DVVHVVPHQW RU IROORZ XS
/LSLG SUR¿OH 7RWDO +'/ /'/ &KROHVWHURO 7ULJO\FHULGHV IDVWLQJ
)ROORZ XS RI WUHDWHG K\SHUFKROHVWHUROHPLD $SR% RQO\ IDVWLQJ QRW UHTXLUHG
&KURQLF YLUDO KHSDWLWLV XQGH¿QHG HWLRORJ\
6LWH 2WKHU
+HSDWLWLV % +%V$J DQWL +%F DQWL +%V
+HSDWLWLV & DQWL +&9
9$*,1,7,6
,QYHVWLJDWLRQ RI KHSDWLWLV LPPXQH VWDWXV
&KURQLF UHFXUUHQW VPHDU FXOWXUH 7ULFKRPRQDV
+HSDWLWLV $ DQWL +$9 WRWDO
+HSDWLWLV % DQWL +%V
7ULFKRPRQDV WHVWLQJ
+HSDWLWLV PDUNHU V
,QLWLDO VPHDU IRU %9 \HDVW RQO\
6HOI SD\ OLSLG SUR¿OH QRQ 063 ELOODEOH IDVWLQJ
7+<52,' )81&7,21 )RU RWKHU WK\URLG LQYHVWLJDWLRQV SOHDVH RUGHU VSHFL¿F WHVWV EHORZ DQG SURYLGH GLDJQRVLV 6XVSHFWHG +\SRWK\URLGLVP 76+ ¿UVW I7
6XVSHFWHG +\SHUWK\URLGLVP 76+ ¿UVW I7 I7
*5283 % 675(3 6&5((1 3UHJQDQF\ RQO\
9DJLQR DQRUHFWDO VZDE 3HQLFLOOLQ DOOHUJ\
+%V$J )RU RWKHU KHSDWLWLV PDUNHUV SOHDVH RUGHU VSHFL¿F WHVW V EHORZ
&+/$0<',$ &7 *21255+($ *&
+,9 6(52/2*< 3DWLHQW KDV OHJDO ULJKW WR FKRRVH QRPLQDO RU QRQ QRPLQDO UHSRUWLQJ
&7 *& WHVWLQJ 6RXUFH VLWH 8UHWKUD &HUYL[ 8ULQH *& FXOWXUH 7KURDW 5HFWDO
1RPLQDO UHSRUWLQJ
0RQLWRU WK\URLG UHSODFHPHQW WKHUDS\ 76+ RQO\
1RQ QRPLQDO UHSRUWLQJ
27+(5 &+(0,675< 7(676 6RGLXP
$OEXPLQ
&UHDWLQLQH H*)5
3RWDVVLXP
$ON SKRV
&DOFLXP
$/7
7 3URWHLQ
+LVWRU\ RI EORRG\ VWRROV" <HV & GLI¿FLOH WHVWLQJ 6WRRO RYD SDUDVLWH H[DP 6WRRO RYD SDUDVLWH KLJK ULVN VDPSOHV
'(50$723+<7(6 .2+ SUHS GLUHFW H[DP
6SHFLPHQ 6NLQ 1DLO +DLU 6LWH
36$ VFUHHQLQJ VHOI SD\
27+(5 7(676 6WDQGLQJ RUGHU UHTXHVWV H[SLU\ IUHTXHQF\ PXVW EH LQGLFDWHG
6WRRO FXOWXUH
0<&2/2*< <HDVW
36$ 063 ELOODEOH
**7
6722/ 63(&,0(16
'HUPDWRSK\WH FXOWXUH
&UHDWLQH NLQDVH &.
%LOLUXELQ
2WKHU
HIV plasma viral load CD4/CD8 cell counts and percentage HLA B5701 (CfE HIV/AIDS requisition included) Syphilis RPR Hepatitis C qualitative PCR Toxoplasma IgG 6,*1$785( 2) 3+<6,&,$1
&
(&*
)HFDO RFFXOW EORRG
AST LDH Amylase Cl HCO3 BUN '$7( 6,*1('
)XQJXV 6LWH
'$7( 2) &2//(&7,21
7,0( 2) &2//(&7,21
3+/(%2720,67
7(/(3+21( 5(48,6,7,21 5(&(,9(' %< HPSOR\HH GDWH WLPH
,16758&7,216 72 3$7,(176 VHH UHYHUVH
2WKHU LQVWUXFWLRQV
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