HIV: Less-frequent CD4 monitoring safe, less costly

Checking CD4 helper T cell levels up to 4 times a year has been a mainstay of HIV/AIDS monitoring, but the value of the test has diminished as the ability to directly detect viral RNA has improved and therapies have become more effective. It may be time to change the standard of care and minimize use of the costly CD4 test in patients who have no evidence of HIV RNA in their blood, according to a research letter published online August 27 in JAMA Internal Medicine.

The Centers for Disease Control and Prevention estimates that 80% of the 336,000 of the 1.2 million people with HIV/AIDS in the United States have stably suppressed infections. A CD4 test costs $38 to $67; the higher cost is for tests that include CD4 percentage.

Emily P. Hyle, MD, from Massachusetts General Hospital in Boston, and colleagues translated these statistics into possible dollars saved by limiting CD4 testing. Using the conservative $38 minimum cost per patient, the researchers estimate that CD4 testing annually rather than biannually would save $10.2 million per year. The corresponding figure for using the more expensive test is $18.1 million. The combined savings during the lifetimes of patients would range from $225.7 million to $615.1 million.

Savings would be even greater for medical practices that now routinely test for CD4 T cells quarterly. The researchers even suggest that CD4 testing cease permanently for stable patients.

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