Monitoring Viral Loads, CD4+ counts do not affect survival rates

From Today's Kaiser Daily HIV/AIDS Report

Science & Medicine | Tests Monitoring Viral Loads, CD4+ Count Do Not Significantly Affect Survival Rates Among HIV-Positive People, Study Finds

[Apr 28, 2008]

Survival rates among HIV-positive people who undergo routine viral load and CD4+ T cell counts were nearly the same as those who do not receive the tests, according to a study published on Friday in the journal Lancet, the CP/Google.com reports (CP/Google.com, 4/24). In some wealthy countries, HIV-positive people undergo routine laboratory screening -- which can cost about $20 to $60 -- about every six months. In many developing countries, HIV-positive people usually are monitored by a physician or nurse for clinical signs of disease progression (Cheng, Associated Press, 4/24).

For the study, Andrew Phillips from the Royal Free and University College Medical School and Charles Gilks -- head of treatment, prevention and scale-up at the World Health Organization's HIV/AIDS Programme -- used a computer model that simulated patient details based on HIV progression in real people living with the virus, Reuters reports. The researchers projected survival rates for up to 20 years. The study found that after five years, 83% of the simulated HIV-positive people who were monitored with the viral load tests survived, compared with 82% for those who received CD4+ monitoring and 82% for those who were received clinical monitoring. Over two decades, the projected survival rates were 67%, 64% and 64%, respectively, the study found (Nebehay, Reuters, 4/24).

"The results of this study should reassure clinicians in Africa and Asia, who are treating literally millions of people without these laboratory tests, that they are not compromising patient safety," Gilks said. He added, "In fact, the outcome of their treatment is almost as good as those patients in the [U.S.] and Europe, where laboratory-guided treatment is the norm" (AFP/Channel NewsAsia, 4/25). As antiretroviral drugs have been distributed in developing countries, some doctors worry that without lab monitoring, HIV-positive people will die earlier or develop drug resistance faster, the CP/Google.com reports. However, based on the evidence to date, that has not happened (CP/Google.com, 4/24).

Phillips said, "Laboratory monitoring shouldn't be the priority while we've got less than half of people who need treatment still waiting for it" (Associated Press, 4/24). "Waiting for the perfect lab infrastructure to be ready before rolling out antiretroviral therapy means that millions of people will die," Jennifer Kates, vice president and director of HIV policy for the Kaiser Family Foundation, said, adding, "This study says we shouldn't wait" (CP/Google.com, 4/24). Gilks said that the tests "obviously do help, but if you don't have tests available, the priority remains to get drugs there in the first instance." He added that antiretrovirals are the "most important thing because without them, people die, it is as simple as that" (Reuters, 4/24).

According to the Associated Press, although the study results still have to be verified, they could affect how HIV-positive people "across Africa and Asia are treated." The original computer model was developed by Phillips with funding from Pfizer (Associated Press, 4/24).

The study is available online.