What to Expect

Following the first visit, the doctor may order tests and exams, such as blood tests, to help improve the care provided and understand the needs of your child. Follow-up care is very important in HIV and other infectious disease care. Follow-up appointments typically occur on a monthly basis. Your family will also stay in touch with your social worker who will work with other pediatric specialists to ensure up-to-date care for you and your child.

Ask Questions & Partner with the Care Team

It is very important that you ask questions about your child’s visit to Miller Children’s Bickerstaff Pediatric Family and Center. Miller Children’s values your input as a parent and wants you to make informed decisions for your child. No question is too small or unimportant.

• Keep your child at ease by explaining that the doctor and care team are here to help.
• Reassure and comfort your child through the process of the visit, exam and procedures or tests, with their favorite book or blanket.
• When a parent understands the diagnosis and treatment plan fully, they can help ease their child’s worries and can answer their questions.

CD4 Count Test In Children

A CD4 test is completed to determine if an HIV-positive child requires treatment. This measures the number of T-helper cells – white blood cells that are attacked by HIV – in a child’s blood. It can either measure the absolute number of CD4 cells, or the percentage of white blood cells that are CD4 cells, in a sample of blood.

Typically if a child has a falling CD4 count, it could be seen as a sign that HIV is progressing, and that the immune system is becoming weaker. Anti-retroviral treatment is usually started once the absolute CD4 count dips quite low. However, absolute CD4 counts vary with age, and younger children usually have a much higher CD4 count. For children under the age of 5, this makes it very difficult to judge the health of a child’s immune system.

Percentage CD4 count does not vary in the same way as absolute CD4 count, and therefore is recommended for children under five. In some cases, viral load testing is used to measure the amount of HIV in an individual’s blood. This test alongside CD4 testing can help guide decisions about treatment.

In general, all diagnosed children under 12-months should begin anti-retroviral therapy regardless of the infant’s clinical or immunological stage. The United States has followed the lead of the World Health Organization (WHO) and now recommends treatment, rather than the consideration of treatment, for all infants with HIV, regardless of CD4 percentage, clinical status or viral load.

Dose of Anti-retroviral (ARV’s) Drugs

The dose of anti-retroviral drugs (ARVs) given to children is based on weight or body surface area and metabolism. Since children are constantly growing, drug doses need to be constantly monitored and changed to ensure that a child is not given too much, or too little, of an anti-retroviral drug. Also, children under the age of 6 metabolize drugs faster than adults, so higher quantities of ARVs may be given. This is why follow-up appointments are crucial and should be kept as much as possible.

Fixed-dose combination therapies (FDCs), combine multiple ARVs into a single tablet for children. This makes it easier for them to take. Infants who are too young to swallow tablets, may need to take their dosage in the form of syrups or powders.

It is important for your child to take their medication as directed and not skip or miss a dose. Please contact the Bickerstaff Pediatric Family Center if you have any questions or concerns.