Less frequent CD4 and viral load tests
In recent years, there has been a shift to people who are doing well on HIV treatment having their viral load and CD4 counts monitored less frequently. But how safe is this? Do people with less frequent blood tests have good outcomes?
A large observational study, looking at data from almost 40,000 people from Europe and the United States, has looked into this issue. The researchers examined the results of people who began HIV treatment and who had an undetectable viral load within a year.
After this point, their CD4 and viral load was monitored according to one of three strategies:
- every three months
- every six months
- every nine to twelve months.
Two years later, there were no differences in the most important clinical outcomes – AIDS-related illnesses or deaths. These events were rare but were spread evenly between the groups.
The researchers then looked at people having a sustained increase in viral load above 200 copies/ml, in other words ‘virological failure’. People who had monitoring every six months were no more likely to have this happen than people with monitoring every three months.
But people with monitoring every nine to twelve months did experience more cases of virological failure. They also had very slightly lower CD4 counts. The researchers speculated that this might be due to gaps in adherence in some people who have less frequent monitoring.
The researchers concluded that the frequency of monitoring for people with an undetectable viral load can be safely reduced from every three months to every six months.
One issue which this study doesn’t shed light on is the frequency of checking viral load, compared with the frequency of checking the CD4 count. For people who are stable and doing well on treatment, viral load is the most important test, whereas CD4 results are unlikely to affect decisions about treatment.
As a result, proposed new guidelines from the British HIV Association suggest that, once people have had an undetectable viral load for at least a year, their viral load should be checked every three to six months, but their CD4 count no longer needs to be monitored. But if their viral load increased, or they had HIV-related symptoms, then the CD4 count would be monitored again.
To find out more on this issue, read NAM’s booklet ‘CD4, viral load & other tests’.
Drugs or alcohol?
The Gay Men’s Sex Survey recently asked gay men living with diagnosed HIV, “How large a part do you think alcohol played in your acquiring HIV?” They were asked a similarly worded question about recreational and illicit drugs.
Whereas 31% said that alcohol played a part in their HIV infection, 23% thought other drugs played a part. This suggests that alcohol plays as big a role as drugs or ‘chemsex’ in men acquiring HIV.
And more than half of men (58%) said that neither drugs nor alcohol played a role in them becoming HIV positive.
The survey also showed that one of the most important ways which gay men with HIV reduce risks during sex is to know their current viral load (72%). Many more men mentioned this than using condoms (35%).
Whereas 63% of HIV-negative men said they avoided partners who have HIV, 27% of HIV-positive men avoided partners who do not have HIV.
Men completing the survey also reduced risks by using lubricant for intercourse, having regular sexual health check-ups and getting infections treated, talking about HIV and STIs with potential sex partners and avoiding anal sex altogether.
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