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Special Considerations for Children
Î HIV-infected infants should undergo HIV resistance testing (SR-H) and,
because of the rapid progression of disease, should initiate therapy in
the first year of life regardless of CD4 cell count, RNA level, or clinical
status (SR-H).
Î After the first year of life, initiation of therapy in HIV-infected children
is based on age, CD4 count/percentage, viral load, and symptoms.
ART should be initiated in all symptomatic children (SR-H).
• CD4 cell counts and viral loads should be monitored no less than every 3-4
months (SR-M).
• Childhood vaccinations should be administered according to Advisory
Committee on Immunization Practices schedules for HIV-infected infants and
children (SR-H).
Î HIV-infected infants and children should be managed by a specialist
with knowledge of the unique therapeutic, pharmacologic, behavioral,
and developmental issues associated with this disease (SR-L).
Special Considerations for Adolescents
Î HIV-infected adolescents require an individual and developmental
approach to therapy and care given by an HIV specialist with expertise
in this population (SR-L).
Î Adolescents infected with HIV should have a coordinated, deliberate
transition to adult care (SR-L).
Metabolic Comorbidities Associated With HIV and ART
Î Fasting blood glucose and/or hemoglobin A1c measurements should
be obtained prior to and within 1-3 months after starting ART. Patients
with diabetes mellitus should have their hemoglobin A1c level
monitored every 6 months with a goal of <7%, in accordance with the
American Diabetes Association guidelines (SR-M).
Î Fasting lipid levels should be obtained prior to and within 1-3 months
after starting ART. Patients with abnormal lipid levels should be
managed according to the National Cholesterol Education Program
guidelines (SR-M).
Î Baseline bone densitometry (dual-energy x-ray absorptiometry, or
DEXA) screening for osteoporosis in HIV-infected patients should be
performed in postmenopausal women and men age ≥50 years (SR-M).
