Further Inpatient Care
- Based on the patient’s living arrangements and stage of infection, inpatient care may be warranted at some time during the patient’s illness.
· The extensive testing required to rule out an underlying infection or a malignancy may be easiest performed if the child is admitted to a health care facility.
- If an infection or a malignancy is detected, hospital admission may be appropriate. For example, if intravenous antibiotics are given, a child is usually admitted to the hospital. A serious reaction to an antiviral drug may also mandate hospitalization to follow up on the progression of the reaction and to observe the patient if new drugs are begun.
- Maintain an established vaccination schedule in children who are HIV positive to protect them against vaccine-preventable illnesses.
- Based on the child’s age and immune status, clinical outpatient follow-up is necessary. CD4+ counts must be closely monitored, and neurodevelopment should be frequently assessed. In younger children, evaluations should occur every 1-6 months. In older children, a review of systems is advised every 3 months and a physical evaluation should be performed every year. CD4+ counts must be checked every 3-6 months.
- Accurate and routine height and weight documentation is important in children with AIDS because HIV is known to adversely affect growth rates in children. Recent evidence indicates that children with improved height growth velocity are less likely to exhibit virologic or immunologic failure and less likely to have clinical disease progression.
- Examinations by specialists should occur routinely. The patient should follow up with an ophthalmologist every 6-12 months and a dentist every 3-6 months.
- The requirement of laboratory monitoring for the specific antiviral drug dictates the frequency of laboratory monitoring.
- UNAIDS, UNICEF, USAID. Children on the Brink 2004: A joint report of new orphan estimates and a framework for action. UNICEF. Available at http://www.unicef.org/publications/index_22212.html. Accessed 2004.
- UNAIDS, WHO. UNAIDS/WHO AIDS Epidemic Update:. UNAIDS. Available at http://www.unaids.org/en/HIV_data/epi2006/default.asp. Accessed 2006.