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Read Now: News and Research From IDWeek 2014

Commentary & Opinion

JAMA Internal Medicine Editorial Questions the Necessity of CD4 Tests in Virally Supressed Patients

August 28, 2013

Today we have highly effective antiretroviral treatment for human immunodeficiency virus (HIV) and a much better marker of how our patients are doing: the HIV viral load. Patients with undetectable virus in their blood are likely to do well as long as they keep taking their medication. The first sign of trouble is an elevated viral load. ... So, if CD4 counts are no longer driving treatment decisions in stable patients who are virally suppressed while receiving antiretroviral treatment, why do we still order these tests? Because it is our habit, and our patients expect it. Although ordering the test likely causes little harm to our patients (unnecessary anxiety if there is a false-negative drop in the count), the tests are expensive (Dr. Mitchell H. Katz, JAMA Internal Medicine, 8/26).

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.




Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.
 

Reader Comments:

Comment by: harleymc (Sydney) Wed., Aug. 28, 2013 at 4:40 pm EDT
If we could tell viral load by an external exam then we wouldn't need blood tests. At the time of ordering blood tests there is no way of determining whether or not viral supression exists.

So if there is a viral rebound then the patient has to be contacted and fresh bloods drawn, depending on patient circumstances this may be a significant harm involving for instance, extensive travel, disruption to work or other income stream, disruption to normal childcare. These harms are usually externalised from health care costings but are real and significant.

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