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Research Letter | Health Care Reform

Potential Savings by Reduced CD4 Monitoring in Stable Patients With HIV Receiving Antiretroviral Therapy

Emily P. Hyle, MD1 ; Paul E. Sax, MD2; Rochelle P. Walensky, MD, MPH1
[+] Author Affiliations
1 Division of Infectious Diseases, Massachusetts General Hospital, Boston
2Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. 2013;173(18):1746-1748. doi:10.1001/jamainternmed.2013.9329.
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The appropriate monitoring of chronic disease conditions offers high-yield opportunities to improve the value of medical care by reducing excess testing. For people living with human immunodeficiency virus (HIV)/AIDS in the United States who are virologically suppressed while receiving antiretroviral treatment (ART), HIV has become a chronic condition. The 2013 Department of Health and Human Services Guidelines for Adult and Adolescent HIV Care recommend CD4 monitoring every 6 to 12 months “in clinically stable patients with suppressed viral load [no detectable HIV RNA in blood],” although some clinicians perform this test quarterly.1 Recently published data show that CD4 results in such patients rarely (if ever) influence management.2 We sought to estimate how reduced CD4 testing frequency in virologically suppressed patients could contribute to savings at the US population level.

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