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Author Topic: New DHHS Treatment Guidelines  (Read 674 times)

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Offline tednlou2

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  • Posts: 4,841
New DHHS Treatment Guidelines
« on: May 02, 2014, 02:21:17 AM »
I know many doing well on meds are having their CD4 checked once a year.  The guidelines recommend that for those successfully treated for 2 years or more.  The interesting thing was the recommendation to make CD4 testing optional for those with counts higher than 500, with some exceptions.

http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/37/whats-new-in-the-guidelines-

Offline Hellraiser

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Re: New DHHS Treatment Guidelines
« Reply #1 on: May 02, 2014, 09:41:10 AM »
Interesting, Rilpivirine (Complera) was suggested only for people over 200 CD4.  I know it was initially suggested for the treatment naive but I basically browbeat my doctor into prescribing it for me.  I know for a fact my CD4 was under 200 when I started.

Offline Miss Philicia

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Re: New DHHS Treatment Guidelines
« Reply #2 on: May 02, 2014, 11:08:35 AM »
The change in cd4 testing frequency is only discussed as a cost consideration. Also keep in mind that only something like 21% remain in care consistently, adhere to medication and have consistently suppressed viral loads, so in fact these recommendations only apply to a rather small segment of patients in any one setting.

cd4 testing is nowhere near as expensive as viral load testing. $243 vs $470 -- not to mention testing for full STI panel is $285 (chlamydia/gonorrhea/syphilis)

But certainly if a patient is receiving medical care through Ryan White and has a cd4 count conducted every 6 months then you'll see a savings of $243 per patient. It's not relevant for private insurance unless this causes Medicare to limit testing and then private insurance follows suit, something that often takes years to happen.
"I’ve slept with enough men to know that I’m not gay"

Offline xinyuan

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Re: New DHHS Treatment Guidelines
« Reply #3 on: May 04, 2014, 01:02:19 PM »
CD4 testing isn't the only important change to the new guidelines.

The authors also added new recommendations on switching regimens.

Hopefully, this section will clear up some things for people looking to switch.

Offline vertigo

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Re: New DHHS Treatment Guidelines
« Reply #4 on: May 04, 2014, 02:38:30 PM »
I see they also no longer recommend testing for lymphocytes other than CD4, i.e. no more CD8 testing.  My doc has adopted this practice, too.  My last set of labs did not include CD8 results.  Seems like the CD4/CD8 ratio is oftentimes screwed up for pozzies, but since it doesn't inform any treatment decisions, I guess why bother with it.

Offline OneTampa

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  • "Butterflies are free."
Re: New DHHS Treatment Guidelines
« Reply #5 on: May 04, 2014, 04:55:40 PM »
Ted,

Thanks for the linked information.

It seems that my Doctor is again ahead of the curve.

Best.
"He is my oldest child. The shy and retiring one over there with the Haitian headdress serving pescaíto frito."

Offline buginme2

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Re: New DHHS Treatment Guidelines
« Reply #6 on: May 04, 2014, 05:33:56 PM »
I'd be happy to defer having a cd4 count done.  As it is now they only do it once or twice a year and that seems kind of pointless.  A CBC and viral load is adequate.

A savings of $500 a year is still pretty good. 


Offline vertigo

  • Member
  • Posts: 139
Re: New DHHS Treatment Guidelines
« Reply #7 on: May 07, 2014, 05:28:53 AM »
Dr Paul Sax has a nice concise spin on the revised guidelines.  He's always a great read.  Has also been a big proponent of less-frequent CD4 testing.

http://blogs.jwatch.org/hiv-id-observations/index.php/the-top-items-from-the-revised-dhhs-hiv-treatment-guidelines/2014/05/03/

Online mecch

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Re: New DHHS Treatment Guidelines
« Reply #8 on: May 07, 2014, 07:32:50 AM »
Also keep in mind that only something like 21% remain in care consistently, adhere to medication and have consistently suppressed viral loads,
Yikes that is for all HIV+ people who start treatment in the USA?  Or a particular subset / group?
“From each, according to his ability; to each, according to his need” 1875 K Marx

 


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