Monitoring AIDS Treatment by Physical Symptoms May Be As Effective As Lab Tests

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Title: Monitoring AIDS Treatment by Physical Symptoms May Be As Effective As Lab Tests
URL: http://www.pslgroup.com/dg/22022A.htm
Doctor's Guide
April 25, 2008

GENEVA -- April 25, 2008 -- According to a study published today in The Lancet, clinicians who use simple physical signs of deteriorating health (ie, weight loss, fever) may provide therapies almost as effective as other clinicians relying on the most advanced laboratory analysis.

The study looked at the medium- and long-term consequences of different approaches to monitoring antiretroviral therapy in a resource-limited setting: using clinical signs and symptoms alone as recommended in World Health Organization (WHO) guidelines; or more sophisticated and costly -- but far less accessible -- immunologic and virologic load tests. The scientists used a model that had been tested in London, which accurately predicts the course of the epidemic in the United Kingdom over 20 years, but with various changes to reflect realities on the ground.

According to the study authors, survival rates for individuals assessed for clinical symptoms alone were almost identical to survival rates for those who underwent laboratory monitoring. The 5-year survival rate was 83% for individuals monitored for viral load, 82% for CD4 monitoring, and 82% for clinical monitoring alone. Corresponding values over a 24-year period were 67%, 64%, and 64%, respectively.

Although the survival rate was slightly higher with viral load monitoring, study authors pointed out it was not the most cost-effective strategy in the poorest countries. The study also examined whether clinical observation alone was effective in determining when to switch patients from WHO-recommended first-line treatments to more costly second-line medicines. Again, diagnosis based on an assessment of clinical symptoms was shown to be almost as effective as those relying on expensive laboratory tests.

The study authors concluded that for patients on the WHO first-line regimen of stavudine, lamivudine, and nevirapine, the benefits of CD4 count or viral load monitoring were only modest at best.

"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," said coauthor Dr. Charles Gilks, Coordinator of Antiretroviral Treatment and HIV Care, WHO, Geneva, Switzerland. "In fact, the outcome of their treatment is almost as good as of those patients in the United States and Europe, where laboratory-guided treatment is the norm."

The study, conducted by a prominent group in the United Kingdom working with WHO scientists, employed mathematical models that were designed to identify emerging problems and problems that might appear after long-term use of antiretroviral treatment; however, it is not based on real-world patients. Other studies are ongoing and more results should be available soon.

SOURCE: World Health Organization

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