New DHHS Treatment Guidelines

[tednlou2]

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-

[Hellraiser]

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.

[Miss Philicia]

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.

[xinyuan]

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.

[vertigo]

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.

[OneTampa]

Ted,

Thanks for the linked information.

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

Best.

[buginme2]

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. 

[vertigo]

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/

[mecch]

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?