Clinical and Laboratory Monitoring of Children Before and After Initiation of ART
DIAGNOSIS/BASELINE | ART INITIATION | 1–2 WEEKS OF THERAPY | 4–8 WEEKS OF THERAPY | EVERY 3–4 MONTHSa | EVERY 6–12 MONTHS | |
Clinical history and physical examination | X | X | X | X | X | X |
CBC count with differential | X | X | X | X | ||
Electrolytes, glucose, BUN, creatinine, bilirubin | X | X | X | |||
AST and ALT | X | X | Xb | Xb | X | |
Albumin, total protein, calcium, phosphate | X | X | X | |||
CD4 cell count or percentage | X | X | Xc | X | ||
HIV RNA (viral load) | X | X | X | X | X | |
Drug resistance testing | X | |||||
Adherence evaluation | X | X | X | X | ||
Lipid panel | X | X | X | |||
Urinalysis | X | X | X |
ALT=alanine aminotransferase; ART=antiretroviral therapy; AST=aspartate aminotransferase; CBC=complete blood cell; HIV=human immunodeficiency virus.
Adapted from Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. (17)
↵a For children who are on stable ART, many clinicians consider 6-month intervals between monitoring laboratory tests.
↵b In children receiving nevirapine, serum transaminase levels should be measured every 2 weeks for the first 4 weeks of therapy, then monthly for 3 months, and every 3 to 4 months thereafter.
↵c Some clinicians do not recommend a CD4 cell count or percentage at this time, considering it too early to expect an immunologic response.