Table 5.

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)

^aFor children who are on stable ART, many clinicians consider 6-month intervals between monitoring laboratory tests.

^bIn 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.

^cSome clinicians do not recommend a CD4 cell count or percentage at this time, considering it too early to expect an immunologic response.