Spectrum: Local Antimicrobial Stewardship, for Yangon Children's Hospital

Monitoring

Note

CD4% is preferred in children <5 years and CD4 count is preferred in children >5 years

To calculate the CD4% and count, a full blood cell count (FBC) needs to be performed

Identify concomitant medications that may produce drug interactions with ART

Laboratory Monitoring by Phase of HIV Management

HIV Diagnosis

Recommended:

  1. HIV testing (as per early infant diagnosis algorithm)
  2. CD4 count
  3. TB symptom screening

Desirable:

  1. HBV (HBsAG - Hepatitis B surface antigen) serology
  • HBsAG testing should be performed at baseline to identify HIV/HBV co-infected patients who should initiate TDF (tenofovir)-containing ART (which is only approved for use in >2 years)
    1. HCV (Hepatitis C virus) serology

Follow-Up Before ART

Recommended:

  • CD4 count (every 6-12 months in circumstances where ART initiation is delayed)

ART Initiation

Recommended:

  • CD4 count

Desirable:

  • To be performed at baseline:

    • If starting AZT (zidovudine): Hb (serum haemoglobin)
    • If starting TDF (tenofovir): sCr (serum creatinine), eGFR (estimated glomerular filtration rate)
    • If starting NVP (nevirapine): ALT (alanine aminotransferase)

Receiving ART

Recommended:

  • HIV viral load at 6 months and 12 months post ART initiation, THEN 12 monthly thereafter

Desirable:

  • If on TDF (tenofovir): sCr (serum creatinine) and eGFR (estimated glomerular filtration rate) at least 12 monthly