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Clinical Symptoms Enough to Switch Drug Regimens for HIV Patients
Date:4/24/2008

trategies: monitoring viral load and CD4 cell count or clinical observation.

Over a period of five years, 83 percent of patients using the viral load monitoring strategy, 82 percent using CD4 cell count monitoring, and 82 percent using clinical monitoring survived.

After a period of 20 years, survival rates were 67 percent, 64 percent and 64 percent, respectively. Viral load monitoring showed a slightly longer survival but was not the most cost-effective avenue (at a cost of around $3,500 per life-year gained).

Other experts were concerned that the results might be construed to mean viral load monitoring and CD4 cell count should be abandoned in the developed world.

"It's a great study, but it has no application to First World countries," said Dr. Michael Horberg, director of HIV/AIDS policy at Kaiser Permanente Health Plan in Santa Clara, Calif. "There is wide availability of these tests, and there should be funds to support such monitoring.

"Having said that, it has to be well-acknowledged that in resource-limited nations, CD4 count and viral load monitoring are expensive and have limited availability, and clinical decisions have to be made on the basis of clinical impressions," Horberg continued. "Health-care infrastructures must be sent to resource-limited nations. However, in the interim, clinicians should at least be reassured that their clinical practices are not doing undue harm.

"Infectivity seems to be increased with increased viral load. Not monitoring viral load could mean that highly infectious patients are passing the virus to new people and, indeed, a virus which is already resistant to drugs."

More information

The World Health Organization has more on antiretroviral therapy for HIV infection.



SOURCES: Andrew N. Phillips, Ph.D., professor, epidemiology
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