Immunological Monitoring in Children

CD4 lymphocyte counts are at their highest level during infancy, but gradually decline, reaching adult levels at approximately 6 years of age. A pediatric immunologic and clinical HIV staging system has been developed (see Table I).

It is important to recognize that CD4 percentage identifies the specific level of immunologic suppression, whereas the CD4 absolute count changes with age; therefore, CD4 percentage may be a more valuable monitoring tool than absolute count in children. CD4 monitoring should be done at 3-

TABLE I

1994 Revised Pediatric HlV Classification System: Immunologic Categories Based on Age-specific CD4+ Lymphocyte Count and Percentage

TABLE I

1994 Revised Pediatric HlV Classification System: Immunologic Categories Based on Age-specific CD4+ Lymphocyte Count and Percentage

Age <12 months

Age 1

-5 years

Age 6-

12 years

Immune

Number/

Number/

Number/

category

Hl

(%)

Hl

(%)

Hl

(%)

Category 1: No

>1500

( >25%)

>1000

(>25%)

>500

(>25%)

suppression Category 2: Moderate

750-1499

(15-24%)

500-999

(15-24%)

200-499

(15-24%)

suppression Category 3: Severe

<750

(<15%)

<500

(<l5%)

<200

(<15%)

suppression

"Modified from ref. 48.

"Modified from ref. 48.

month intervals, with increased frequency at the initiation of antiretro viral therapy or change in antiretroviral therapy. Intercurrent illness and immunization affects CD4 count and should be taken into consideration, with repeat samples obtained when there is concern regarding these influences.

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