Table 3. Sample Schedule for Clinical and Laboratory Monitoring of Children Before and After Initiation of Antiretroviral Therapya

Table 3. Sample Schedule for Clinical and Laboratory Monitoring of Children Before and After Initiation of Antiretroviral Therapy
Laboratory Testing Entry Into Careb Pre-Therapyc ART Initiationd Weeks 1–2 on Therapy Weeks 2–4 on Therapy Every 3–4 Monthse Every 6–12 Monthsf Virologic Failure (Prior to Switching ARV Regimens)
Medical History and Physical Evaluationg  
Adherence Evaluation    
CD4 Count      
Plasma Viral Load    
Resistance Testing            
CBC with Differentiale    
Lipid Panel          
Random Plasma Glucosei            
HBV Screeningj            
Pregnancy Test for Women of Childbearing Agek            

a Virtual visits may be appropriate at some time points, particularly for adherence assessments and for visits for established patients, see Table A.

b See text for details on recommended laboratory tests to perform.

c A patient’s ability to adhere to an ARV regimen is assessed prior to starting ART. When ABC is being considered as part of the regimen, send HLA-B*5701 testing prior to initiating ABC and choose an alternative ARV drug if the patient is HLA-B*5701 positive (see the Abacavir section in Appendix A: Pediatric Antiretroviral Drug Information). Genotype resistance testing is recommended if it has not already been performed (see Drug-Resistance Testing in the Adult and Adolescent Antiretroviral Guidelines). Send tests that are appropriate for the toxicity profile which is associated with the patient’s ARV regimen and the patient’s medical history (see text).

d If ART is initiated within 30 days to 90 days of a pre-therapy laboratory result, repeat testing may not be necessary.

e CD4 cell count, CBC, and chemistries can be monitored less frequently (every 6–12 months) in children and youth who are adherent to therapy, who have CD4 cell count values that are well above the threshold for OI risk, and who have had sustained virologic suppression and stable clinical status for more than 2–3 years. Viral load testing every 3–4 months is generally recommended to monitor ARV adherence.

f If lipid levels have been abnormal in the past, more frequent monitoring may be needed. For patients treated with TDF, more frequent urinalysis should be considered.

g Pay special attention to changes in weight that might occur after altering an ARV regimen. Weight gain or weight loss may occur when using some ARV drugs (see Table 15h: Lipodystrophies and Weight Gain).

h Chemistries refer to a comprehensive metabolic panel.

i Random plasma glucose is collected in a gray-top blood collection tube or other designated tube.

i This screening is only recommended for individuals who have previously demonstrated no immunity to HBV and who are initiating a regimen that contains ARV drugs with activity against HBV, specifically 3TC, FTC, TAF, or TDF.

k See the Adult and Adolescent Antiretroviral Guidelines, as well as Preconception Counseling and Care for Women of Childbearing Age with HIV in the Perinatal Guidelines.

Key: 3TC = lamivudine; ABC = abacavir; ART = antiretroviral therapy; ARV = antiretroviral; CBC = complete blood count; CD4 = CD4 T lymphocyte; FTC = emtricitabine; HBV = hepatitis B virus; OI = opportunistic infection; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate