Hi<\/p>\n
Thanks for your question, which I know is shared by other patients at clinics that are trying to reduce the use of some tests.<\/p>\n
The changes are likely to based on looking at results over several years in a group of several thousand patient followed at the Royal Free Hospital, and with the pressure on NHS budgets, you are right that this is driven by cost savings.<\/p>\n
It is worth checking whether the changes are really this drastic. Some of the clinics changing monitoring, will still run both tests, but just less frequently – ie when being followed by CD4 count, you may still have viral load, but perhaps only once a year.<\/p>\n
However, the choice of 3-monthly tests is itself fairly arbitrary. People who are more ill, have always seen their doctor, and been tested, more frequently – and this will still be the case.<\/p>\n
People who are well on stable treatment, in recent years, have generally been going less often, as they realise that the response to treatment is stable and long-term.<\/p>\n
You are right that getting a full picture from both tests is important.<\/p>\n
However, people on stable long-term treatment (undetectable viral load), with a good CD4 count (over 350) very rarely have any significant change in CD4 count. Viral load rarely changes either – but viral load is the key early marker to whether treatment is still working. This will always increase first, and long before any change in CD4 count.<\/p>\n
For people not on treatment, CD4 count is the most accurate and important marker. Although viral load is an independent risk factor for HIV progressing, it is only generally becomes significant as CD4 counts drop below 350, and I’d imagine your clinic would at that point be using both CD4 count and viral load to guide the exact time for starting treatment.<\/p>\n
I know that the Bloomsbury clinic is introducing a similar policy to the one you describe, and this was discussed at the UK CAB (Community Advisory Board)<\/a> in July. Slides and a report from that meeting are online here<\/a>.<\/p>\n The money saved from ‘unnecessary tests’ is sufficient for two nursing posts.<\/p>\n At that centre, they say that people who want more frequent tests will still be able to get them. If you have been on treatment for a few years now, you may also want to track your results and see if they fit the strong pattern above.<\/p>\n If these results are good, then in some ways it is a good thing that you need less frequent monitoring.<\/p>\n However, I’m not sure whether other clinics will follow. Some doctors think that seeing their patients every 3 months has more difficult to measure benefits, in terms of picking up new problems, even in a small group of patients, that is more important than the costs saved from the tests.<\/p>\n","protected":false},"excerpt":{"rendered":" Hello<\/p>\n My clinic is changing procedures (cost-cutting) to only test for: Not to ‘question the experts’, but I was under the impression that a full picture is needed, as the decision of when to start treatment includes a balance of all three results (CD4, Viral Load and Percentage). Is it not possible to have a steady CD4 but rising Viral Load? Or vice versa? Isn’t it important to have a full picture of a situation?<\/p>\n I am considering changing my clinic because of this new procedure, but I am concerned that every clinic is going to move toward doing this.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,9,26],"tags":[],"class_list":["post-186","post","type-post","status-publish","format-standard","hentry","category-all-topics","category-cd4-and-viral-load","category-living-with-hiv-long-term"],"_links":{"self":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/186","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/comments?post=186"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/186\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/media?parent=186"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/categories?post=186"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/tags?post=186"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n* CD4 if you are not on treatment OR
\n* Viral Load if you are on treatment.<\/p>\n