Changing Frequency of Labs/Dr. Visits

[drewm]

May was my 5 years Aids-A-Versary. My numbers have remained steady for 4 years and six months (CD4 230-300s) (VL UD). My cholesterol numbers have also improved significantly and now my ID doc says I can go to bi-yearly labs and appointments.

Thoughts? Opinions??

[bocker3]

May was my 5 years Aids-A-Versary. My numbers have remained steady for 4 years and six months (CD4 230-300s) (VL UD). My cholesterol numbers have also improved significantly and now my ID doc says I can go to bi-yearly labs and appointments.

Thoughts? Opinions??

How do you feel about this??  Are you comfortable going to an every 6 month visit?  What has been your frequency - quarterly?  after about 8 years, I went from quarterly to every 4 months.  I may talk to my doctor about going to twice yearly soon.  It will save me a copay and the time waiting in the office.
Of course, if anything ever feels "off", you can schedule another appt.

[drewm]

How do you feel about this??  Are you comfortable going to an every 6 month visit?  What has been your frequency - quarterly?  after about 8 years, I went from quarterly to every 4 months.  I may talk to my doctor about going to twice yearly soon.  It will save me a copay and the time waiting in the office.
Of course, if anything ever feels "off", you can schedule another appt.

Good question. I started off every month (first three months) then every three months now every 4. Its an exciting thought from the standpoint that everything seems stable enough to make this a reality. On the other hand, I have become accustomed to getting checked every 4 months. Agree about the ability to schedule another appointment. Thanks!

[bocker3]

I guess it really comes down to feeling comfortable.  I mean the reality is that waiting 2 extra months between labs and appts is not likely to allow anything to go "real off" with you -- at least not without you probably realizing that something isn't right.
Having to go to the doctor less not only saves money and time -- it can be an "emotional victory" -- you can look at it as letting the virus have less control over your life.
I do understand that the change can seem big -- but I thought the same when I went from 4x/yr to 3x/yr.  I now see that it was a non-event.

Good luck!
Mike

[AusShep]

I've been doing 6 months for awhile, but I've started scheduling at about 5, since last year due to some schedule changes around the holidays it went to over 7 which seemed like forever.  5-6 works best for me.  I'll probably be back on Jun/Dec next year after my early Dec this year.

4 just really isn't necessary outside of psychological reasons since I almost never have anything out of normal range, and it'll be just barely out and there's usually an obvious explanation in those cases.  I haven't been sick in forever where I'd want to go to the Dr., but I could always schedule an appt then if needed.

I like the Dec schedule, since depending on my insurance plan, I can get any specialist stuff done in the current or following insurance year after seeing my Dr if there is a benefit as far as provider coverage, deductible or out of pocket. 

[drewm]

Thanks guys. Leaning toward the change.

[geobee]

I'm testing at 6 mos now -- things have been stable for 6 years. Also, we're doing fewer tests.  Some of it comes out of pocket, so I'm saving money there.  My doc and I are mostly focusing on VL. If I feel off or whatever, I go in sooner.  Hasn't happened so far!

[leatherman]

interestingly, I just returned from a 2-day Project Inform: Core training where one of the modules was about the frequency of laboratory testing. The most current HRSA/HAB guidelines recently extended the testing range for those who are virally suppressed to once every 6 months in a 24-month period. The word is that the next update will extend VL testing to once a year with cd4 testing optional for PLWH with consistently suppressed viral loads. We should probably see these changes to the Ryan White Core Measurements in the 2016-17 cycle. (Hopefully that change will also standardize the time periods across the measures to be more consistent. )

the current guidelines are:
After 2 years of ART, VL consistently suppressed and CD4 consistently 300-500:
Time between viral load test can extend to every 6 months for patients with consistent viral suppression for >=2 years.
With the cd4 test done every 12 months

After 2 years of ART, VL consistently suppressed and CD4 consistently >500 cells/mm3:
the CD4 test is Optional

https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/458/plasma-hiv-1-rna--viral-load--and-cd4-count-monitoring
"Table 4. Recommendations on the Indications and Frequency of Viral Load and CD4 Count Monitoring"
http://hiv.ucsf.edu/docs/hiv_monitoring_guideline.pdf
"Table. Summary of HIV-specific routine laboratory monitoring" (pg 5)

These guideline changes reflect the science of monitoring patients (who are and are not virally suppressed) to decrease the lab visit burden to patients and the associated costs of those tests (lab work and doctor appts). While that's a win-win for patients (less trips to the doc, less jabs with a needle, and less money spent to health care), in cases where these services are covered through a state's ADAP or Medicaid program, these cost savings will help states to provide more services for even more people.

Of course, any clinical changes or med changes puts a patient at a different testing level with has more frequent testing based on the situation until patients are once again virally suppressed for the recommended length of time.

[drewm]

Thanks guys. Mikie always appreciate your thoroughness 

[wolfter]

Weird that I just came home from my dr's appointment and saw this thread.  I made the same decision today to only do labs every 6 months.  I've progressed with this doctor from having them done daily to this.  He suggested it a while ago but I had that pit in the stomach feeling. 

It took me 2 years of awesome numbers to reach that decision.  Consistently over 900 and UD leads me to this decision.  But ultimately, you need to be comfortable with the decision. 

My doc is also my pcp so I can still reach out if other problems arise.

take care
greg

[Wade]

I have been doing mine every six months for many
years now as I have remained stable, unless required for a surgery or med change.
My last draw was two days ago , Finally made it into the 600s
after all these years !

[drewm]

Thanks guys!

[pittman]

After the first year, I ended up going to every 6 months, and as of two years ago, my CD4 count is only done annually, though my doctor was willing to do it every visit.  He explained it was not needed but he fully understood why his patients often wanted it.

I also go to the Anal Dysplasia Doctor at least once a year, sometimes twice.

I like the fewer visits, though it still cost me the same as I max out my out of pocket expenses after just 1 visit and 1 Rx refill anyway. It just means I have to save up my $2500 or so for the beginning of each year, and after that it's all covered.