Standard clinical monitoring checklist

Clinical description

• Use the summary clinical monitoring checklist to actively screen every exposed child and ART

patient for clinical symptoms at every clinical visit.

• Refer to Table 7 on page 38 for more detailed screening instructions and interpretation of signs

and symptoms for further management.

Table 6: Checklist for clinical monitoring of HIV exp. infants and ART patients Ask for / Examine Appearance: Weight loss / failure to thrive N Y Body shape change / breast swelling (men) N Y Swollen glands N Y Overweight N Y Headache / confusion / dizziness N Y Yellow eyes N Y Mouth sores N Y Cough N Y Shortness of breath N Y Fever / night sweats N Y Vomiting / abdominal pain N Y Diarrhoea N Y Leg pain / numbness / weakness N Y Rash on arms, legs or trunk N Y 38 Table 7: Detailed clinical monitoring list for HIV exp. and ART patients Standard monitoring of HIV patients Ask / Examine Look for Assess Disease (most common) Drug Side-Effects Appearance • Weight loss • Weight loss: trend from patient card / 1) TB Lactic acidosis due to ART

• Failure to thrive health passport 2) Chronic diarrhoea 1) AZT

(failure to gain weight • BMI (adults) 3) Malnutrition in children) • Weight for height, weight for age, MUAC 4) ART failure (children) 5) Malignancy (lymphoma)

• Breast swelling (men) • Breast enlargement (gynaecomastia) Gynaecomastia

Body shape change • Slimming of cheeks 1) EFV

• Slimming of forearms, buttocks and legs ART induced lipodystrophy

+/- protruding veins 1) AZT

• Fattening of chest / belly / buttocks 2) 3TC
• Buffalo hump, swelling abdomen 3) LPV/r
• ATV/r
• DRV + r
• Overweight • BMI >25 1) Lack of physical activity, 1) DTG
• Weight gain on thighs and trunk excess food intake
• Metabolic syndrome
• Swollen glands • Cervical / axillary lymphadenopathy 1) PGL
• EPTB
• Lymphoma
• KS (+/- skin lesions)
• BCG adenitis

Headache, • Neck stiffness 1) Meningitis (bacterial/ TB, 1) EFV

• Nausea / vomiting cryptococcal) 2) INH

confusion, 2) Toxoplasmosis 3) DTG

• Reduced Glasgow

dizziness Coma Scale (GCS) 3) HIV dementia 4) Rifapentine

• Syncope

Ask / Examine Look for Assess Disease (most common) Drug Side-Effects Yellow eyes • Yellow sclera • Jaundice 1) Viral hepatitis Drug hepatitis

• Alcoholic hepatitis 1) NVP
• Malaria 2) EFV
• HCC 3) PZA
• Rifampicin (orange staining)
• Rifapentine (orange stain.)
• INH
• Fluconazole
• DRV/r
• DTG

Hyperbilirubinaemia

• ATV/r

Mouth sores • Mucosa lesions • Whitish patches 1) Oral thrush

• Painful red patches 2) Oral hairy leukoplakia
• Purple lesions 1) KS
• Ulcerations 1) Acute ulcerative stomatitis/ Hypersensitivity

gingivitis/ periodontitis 1) ABC

• Herpes simplex 2) NVP
• Angular cheilitis 3) EFV
• Aphthous ulcers 4) Cotrimoxazole

Standard monitoring of HIV patients 39 40 Standard monitoring of HIV patients Ask / Examine Look for Assess Disease (most common) Drug Side-Effects Cough/ • Any duration • Weight loss/night sweats 1) Pneumonia (bacterial) Hypersensitivity

• Productiveness • Oxygen saturation 2) TB suspect: circle on card 1) ABC

Flu like 3) PCP 2) DRV/r

• Fever

symptoms • Lymphadenopathy 4) KS 3) Rifapentine

• KS lesions 5) COVID-19
• Nasal congestion

Shortness of • Specific breathing • Respiratory rate, pulse rate, Oxygen 1) EPTB Lactic acidosis due to ART patterns saturation, fever 2) Bacterial pneumonia 1) AZT breath 3) PCP

• Chest in drawings • Pulmonary and peripheral oedema
• Heart failure
• KS
• Asthma
• COVID-19
• Conjunctiva • Pale conjunctiva 1) HIV anaemia Anaemia
• Chronic severe malaria 1) AZT
• Nutritional anaemia

Fever / night • History / Duration • Less than 1 month 1) URTI / viral Hypersensitivity

• Current temperature 2) Sepsis 1) ABC

sweats 3) Malaria 2) EFV

• TB 3) RAL
• COVID-19 4) ETV
• DTG
• Cotrimoxazole
• More than 1 month 1) TB
• Malignancies (lymphomas)

Ask / Examine Look for Assess Disease (most common) Drug Side-Effects Vomiting / • Hydration status • Dehydration 1) TB Drug-induced hepatitis

• Palpate abdomen • Tenderness 2) NTS sepsis 1) INH (nausea / anorexia early

abdominal pain 3) Acute Gastro-enteritis sign of INH hepatitis)

• Masses
• Dilated abdominal veins 4) Malaria Drug-induced pancreatitis
• Abdominal TB 1) 3TC
• Ulcer disease 2) RAL
• CNS disease 3) ETV
• Hepatoma 4) DTG

Lactic acidosis due to ART

• AZT

Diarrhoea • History • Less than 1 month 1) Salmonella GI toxicity

• Blood in stool 2) E. Coli 1) LPV/r
• COVID-19 2) AZT
• Amoeba/Shigella 3) ABC
• HIV OI 4) 3TC
• DTG
• Longer than 1 month 1) HIV / OI Pseudomembranous
• Abdominal TB enterocolitis
• Antibiotics

Leg pain, • History • Sleep disturbance (moderate) 1) HIV peripheral neuropathy Drug neuropathy

• Neurological exam • Motor involvement (severe) 2) Spinal TB 1) INH

numbness, 2) AZT weakness Standard monitoring of HIV patients

• Vincristine
• Paclitaxel
• Metronidazole

41 42 Standard monitoring of HIV patients Ask / Examine Look for Assess Disease (most common) Drug Side-Effects Rash on arms, • Skin lesions • Purple lesions 1) KS 1) INH

• Photo dermatitis 2) Pellagra

legs and trunk

• Blisters / vesicles 1) Shingles/ varicella zoster Stevens-Johnson Syndrome
• Cotrimoxazole
• RAL
• Generalized rash • Maculo-papular 1) HIV associated rash (PPE) Skin toxicity
• Fungal skin infections 1) EFV
• Molluscum contagiosum 2) CTX
• Scabies 3) Fluconazole
• DRV/r
• ETV
• DTG

Standard monitoring of HIV patients