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Monitoring Strategy Cost-Effective in HIV Treatment

In poor countries, CD4 count and early HAART initiation offers increase in life expectancy

WEDNESDAY, Sept. 24 (HealthDay News) -- Monitoring CD4 counts in people with HIV in resource-limited countries can considerably improve life expectancy and reduce total costs compared to the usual symptom-based approaches, according to research published in the Sept. 22 issue of the Archives of Internal Medicine.

Eran Bendavid, M.D., of Stanford University in Stanford, Calif., and colleagues created a model comparing three HIV-monitoring approaches: symptom-based strategies in which highly active antiretroviral therapy (HAART) was started when patients developed a severe opportunistic disease; strategies in which HAART was initiated when CD4 counts fell below a certain threshold, unless an opportunistic disease occurred first, and was changed partly based on CD4 counts; and strategies utilizing CD4 counts and viral load.

Compared with symptom-based strategies, monitoring CD4 counts twice a year and starting HAART treatment when they reached 200/μL was associated with a 6.5-month gain in life expectancy (61.9 versus 68.4 months) and a lifetime cost saving of $464 per person, the researchers report. Starting treatment at 350/μL was associated with an additional 5.3 months of life expectancy at $107 per life-year gained, the authors note.

"Addition of viral load monitoring resulted in an additional increase in life expectancy of two months relative to use of only CD4 count monitoring. Two months is an important additional benefit. However, this gain in effectiveness came at a less favorable incremental cost-effectiveness ratio than did CD4 count monitoring because viral load testing is substantially more expensive and provides about a fourth of the benefit of CD4 testing," Bendavid and colleagues write.

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