Less Expensive HIV Treatment Monitoring Methods Just As Effective As Viral Load Testing
A group of international researchers discovered that a far more affordable laboratory test that can help adjust the HIV anti-retroviral treatment may be just as useful as sophisticated traditional tests. This particular finding may have major beneficial effects especially in rural Africa.
Although, the study results still must be confirmed by further clinical trials, the scientists state that viral load testing does not offer any greater benefit compared to the cheaper testing method – CD4 + T lymphocyte count.
No one had directly looked at this question in Africa before, said James G. Kahn, MD, MPH, a professor of health policy, epidemiology, and global health at the University of California, San Francisco (UCSF) who led the economic aspect of the research. If it's true that you are not getting much clinical gain for the buck, maybe we should focus our attention on CD4+ testing.”
HIV attacks the type of immune cells called T-helper. These cells have on their surface a protein called CD4, which HIV uses to attach to the cell before entering it to multiply. T-helper cells play an important role in the immune system by helping to coordinate all other cells in fighting an infection. A major reduction in the number of T-helper cells may have a serious consequences on the immune system proper functioning. HIV causes damage or destruction of the T-helper cells. As a result, there are fewer cells available to help the immune system to fight infection.
The test measures the number of CD4 T-helper cells in blood. The more cells per cubic millimeter a person has, the immune system is stronger. . A low number of CD4 does not necessarily mean that person will get sick, but increases the probability of infections.
The CD4+ count of HIV infected patients usually raises after antiretroviral therapy, thus reducing the risk of infection. Physicians have adapted the antiretroviral treatment for HIV using the CD4+ cell count since the early 1990s. Lately the standard method that guides the treatment in most developed countries, including the US relies on more sophisticated and far more expensive tests, that measure the blood viral load. CD4+ cell count is still a routine test but the viral load test is used to guide treatment decisions, as reducing the number of viral replicas is considered to be the main treatment objective.
The clinical trial included three types of patients from Uganda whose antiretroviral treatment was guided by: viral load testing, CD4+ counts and patients under antiretroviral treatment not guided by any laboratory test. The results were then extrapolated to life expectancy and treatment costs. Patients that were included in the study were visited and tested over the course of one year.
The researchers discovered that the treatment for patients that were monitored by any kind of laboratory test was higher. Monitoring the CD4+ count costs were substantially lower ($5 per test, compared to $3 per test for viral load). Further analysis proved that viral load testing does not necessarily provide extra clinical benefit compared to monitoring the CD4 + T lymphocyte count alone. In the end they concluded that monitoring the CD4 + T lymphocyte count alone could provide substantial benefit at a lower cost.
Viral load testing is very expensive if we think of the frequency with which the test should be performed. A better approach would be to spend the money saved from using less expensive monitoring methods on antiretroviral drugs, extending therefore the life expectancy of patients with limited financial possibilities.