Table 5.

Clinical and Laboratory Monitoring of Children Before and After Initiation of ART

DIAGNOSIS/BASELINEART INITIATION1–2 WEEKS OF THERAPY4–8 WEEKS OF THERAPYEVERY 3–4 MONTHSaEVERY 6–12 MONTHS
Clinical history and physical examinationXXXXXX
CBC count with differentialXXXX
Electrolytes, glucose, BUN, creatinine, bilirubinXXX
AST and ALTXXXbXbX
Albumin, total protein, calcium, phosphateXXX
CD4 cell count or percentageXXXcX
HIV RNA (viral load)XXXXX
Drug resistance testingX
Adherence evaluationXXXX
Lipid panelXXX
UrinalysisXXX
  • 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.