Clinical improvement is the most important indicator to monitor in judging a patient’s response to ART. In general, weight gain and the absence of symptoms indicative of OIs are sufficient clinical markers for assuming a positive response to therapy.

Patients should be seen in clinic monthly, at which time they should be assessed for their adherence to medications; their need for social assistance and nutritional support; and their risk of transmitting the virus, including transmission through any possible pregnancy or to new sexual partners. The patient’s CD4 count and/or viral load, if available, should be checked every three to six months. Screening of all family members and social contacts should also be conducted on a biannual basis.

Common side effects of ART, as discussed in the next section, should be monitored clinically; basic laboratory tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and CBC are useful. Other helpful tests include those for glucose, amylase, lipase, and lactic acid. When such tests are available, CBC and differential, as well as a full chemistry panel, including renal and hepatic parameters, should be performed one month after the initiation of therapy and every six months subsequently; tests should be performed more frequently if a patient exhibits symptoms of ART toxicity.

In children, growth and height should be monitored using standard curves. Doses should be adjusted regularly based on weight gain. Development is also assessed during the monthly clinic visit. Routine testing and follow-up is otherwise the same as for adults.