|
Once a child is on ART, in addition to the parameters used before ART (except for
confirmation of HIV infection status),
clinical assessment
should cover the child's
and caregiver's understanding of the therapy as well as anticipated support
and adherence to the therapy. Observation of the child's responses to therapy
should also include symptoms of potential drug toxicities or treatment failure.
Particularly important signs of infants' and children's responses to ART include
the following:
- improvement in growth in children who have been failing to grow;
- improvement in neurological symptoms and development in children
with encephalopathy or who have been demonstrating delay in the
achievement of developmental milestones; and/or
- decreased frequency of infections (bacterial infections, oral thrush
and/or other opportunistic infections).
The frequency of clinical monitoring depends on the response to ART but should
be at a minimum be at weeks 2, 4, 8 and 12 after starting ART and then every
2-3 months once the child has stabilized on therapy. In infants and children who
were started on ART on the basis of a presumptive clinical diagnosis of severe
HIV disease, HIV infection status should be confirmed as soon as possible.
Laboratory assessment
of CD4 is desirable every six months or more frequently
if clinically indicated (see table below). The TLC is not suitable for the monitoring of
therapy because a change in its value does not reliably predict treatment success. In infants and children initiated on AZT-containing first-line regimens the
measurement of haemoglobin should be performed during the first few months
of treatment (at weeks 4, 8 and 12 after initiation of ART) or in a symptomdirected
approach. Tests of liver function (ie, liver enzymes) are recommended
during the first few months of treatment in infants and children receiving
nevirapine or who have coinfection with hepatitis viruses or are on hepatotoxic
medications. When choosing other laboratory parameters, clinical symptoms
should be taken into consideration for assessing the response to therapy. Some
routine monitoring tests may be advisable in accordance with the specific drugs
used, but laboratory monitoring of adverse events should largely be directed
by clinical symptoms (see Annexes F and G of Report). It should be noted that an inability to
perform laboratory monitoring should not prevent children from receiving ART.
|
HIV diagnostic testing: virological and Ab testing
|
X |
-- |
-- |
-- |
|
Haemoglobin
a
|
X |
X |
-- |
X |
|
WBC and differential
b
|
X |
X |
-- |
X |
|
%CD4 or absolute CD4 cell count
c
|
X |
X |
X |
X |
|
Pregnancy testing in adolescent girls
|
X |
X
d
|
-- |
X |
|
Full chemistry
(including, but not restricted to, ALT,
e
liver enzymes, renal function, glucose, lipids, amylase, lipase and serum electrolytes)
f
|
-- |
-- |
-- |
X |
|
HIV viral load measurement
g
|
-- |
-- |
-- |
X |
|
|
|
