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Routine CD 4 cell count monitoring seldom contributes to clinical decision‐making on antiretroviral therapy in virologically suppressed HIV ‐infected patients
Author(s) -
Chow EPF,
Read TRH,
Chen MY,
Fehler G,
Bradshaw CS,
Fairley CK
Publication year - 2015
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12198
Subject(s) - medicine , antiretroviral therapy , confidence interval , cohort , viral load , retrospective cohort study , human immunodeficiency virus (hiv) , medical record , cohort study , emergency medicine , pediatrics , immunology
Objectives In A ustralia, CD 4 cell count is monitored approximately every 6 months in HIV ‐infected patients during antiretroviral therapy ( ART ). The aim of this study was to determine if routine CD 4 monitoring contributed to decisions on changes to ART , and to estimate how reduced CD 4 monitoring could contribute to cost savings in A ustralia. Methods We conducted a retrospective cohort analysis investigating all HIV ‐infected patients who attended the Melbourne Sexual Health Centre ( MSHC ) in A ustralia from 1 A pril 2011 to 1 O ctober 2013. We reviewed the electronic medical records of all patients who changed or stopped antiretroviral regimens during this time period to determine whether CD 4 cell count could have contributed to this clinical decision. Results Among 1004 patients with HIV infection on ART , none [95% confidence interval ( CI ) 0–2.3%] of the 162 clinical decisions to change or stop treatment were influenced by CD 4 cell counts. Reducing the current biannual CD 4 monitoring strategy to annually could potentially save ∼ AU $ 1.5 million ( US $ 1.4 million) each year in A ustralia [i.e. ∼ AU $ 74 700 ( US $ 67 700) could be saved per 1000 HIV ‐infected patients during ART ]. Conclusions Routine CD 4 monitoring in HIV ‐infected patients during ART could be reduced from biannually to annually, as it rarely influences clinical decisions in patients' management. Not only could this avoid patients being unnecessarily anxious about normal fluctuations in their CD 4 counts but it would also result in cost savings.