How HIV Is Monitored Does Not Affect Survival Rates

Posted Apr 24, 2008 by KJ Mullins
In Africa doctors determine when to switch HIV drugs based on clinical symptoms instead of costly blood work as done in the West. Researchers have found that both set of patients have nearly the same survival rate.
In poorer countries costly blood work is not feasible when deciding which medicines to use with the nearly 2 million patients using HIV drugs. Doctors in these regions have to rely on tracking signs of decline instead. That tracking appears to be almost as reliable as the expensive blood work that Western countries use to gauge where patients disease progress is heading.
The blood work that is standard practise in the West counts the number of CD4 T-cells or the amount of the virus traveling in the bloodstream. The tests are very expensive though.
The new study indicates that perhaps they are not needed as much as a doctor tracking the disease through basic symptoms such as fever and fatigue.
"Our results suggest that use of antiretroviral therapy without monitoring of viral load or CD4 cell count does not have marked detrimental effects on patient survival or on development of resistance," the researchers wrote.
HIV is an incurable virus but has become treatable with drug cocktails that help keep patients alive and in good health.
The study comparing the two means of tracking patient health was led by Andrew Philipps of University College London and included Dr. Charles Gilks on the team.
The study that was published in The Lancet was not based on actual patients but rather mathematical projections using a computer simulation model of HIV infection. The percentage of patients that survive 5 years after diagnose is roughly the same regardless of how a person's disease was tracked.
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," co-author Gilks said in a statement issued by the Geneva-based WHO.
"In fact, the outcome of their treatment is almost as good as those patients in the United States and Europe where laboratory-guided treatment is the norm," he added.
The rough breakdown was;
83 percent in patients using the viral load monitoring strategy
82 percent from CD4 cell count monitor
82 percent with clinical monitoring
In a twenty year projection survival rates were;
67 percent in patients using the viral load monitoring strategy
64 percent from CD4 cell count monitor
64 percent with clinical monitoring
AIDS has killed 25 million people globally and currently there are about 33 million who are infected with the virus.
We're not saying don't do the tests because they obviously do help but if you don't have tests available, the priority remains to get drugs there in the first instance," Gilks told Reuters. "Drugs are the most important thing because without them people die, it is as simple as that."