Originally published on Advocate.com April 30 2008 12:00 AM ET
Patients with HIV
who aren't monitored with the expensive laboratory
tests commonly used in rich countries may survive just as
long as those who do get the tests, a new study says.
In a paper
published in The Lancet medical journal Friday,
experts found only a slight difference between the
survival rates of HIV patients on antiretrovirals who
were monitored with laboratory tests and those who
weren't. Lab tests can be an early indication of problems in
HIV patients that aren't yet obvious.
The research was
based on computer modelling, and while the results must
be verified, they could influence how HIV patients across
Africa and Asia are treated.
As drugs to
combat AIDS have been distributed across developing
countries, some doctors worry that without lab monitoring,
patients will either die earlier or develop drug
resistance faster. But based on the evidence to date,
that has not happened.
''We often get
stuck in letting the perfect be the enemy of the good,''
said Jennifer Kates, an HIV expert at the Kaiser Family
Foundation in Washington. She was not connected to the
''Waiting for the
perfect lab infrastructure to be ready before rolling
out antiretroviral therapy means that millions of people
will die,'' Kates said. ''This study says we shouldn't
and colleagues from the Royal Free and University College
Medical School in London used a computer model that
simulated patient details based on HIV progression in
real patients. They then projected the patients'
survival for up to 20 years. Data from real patients are
not yet available.
Phillips and his
colleagues essentially found that 83% of patients who
were monitored with lab tests survived five years, compared
with 82% for those who went without the tests. Over
two decades, 67% of those who got lab tests survived
versus 64% for those who didn't.
The difference is
negligible -- and contradicts long-held beliefs that
antiretrovirals must be accompanied by regular laboratory
monitoring to benefit patients.
Only half of the
estimated 33 million people with AIDS globally are
receiving the drugs, experts said.
monitoring shouldn't be the priority while we've got less
than half of people who need treatment still waiting for
it,'' Phillips said.
developed the original computer model with funding from
Pfizer Inc., makers of many antiretrovirals, the drugs
used to fight HIV and AIDS.
In the West,
people with HIV undergo routine lab tests about every six
months to check the amount of virus in their body and the
status of their immune systems. The tests cost about
$60 and $20 each time. If a patient has too much virus
or their immune system is weak, doctors usually switch
But in poor
countries, most patients are simply monitored by a doctor or
nurse. Only a few countries in Africa run regular lab tests,
and results often take too long to benefit patients.
patients are only switched to other drugs if they start
developing bacterial infections, skin diseases, or other
suggestions of an AIDS complication.
counterintuitive that people who do not get laboratory
monitoring seem to do just as well as those who do,''
said Charlie Gilks, an AIDS treatment expert at WHO
and one of the paper's authors.
worry that because people who are not monitored with lab
tests stay longer on drugs that don't work, they could be
spreading drug-resistant HIV.
Nathan Ford, head
of Medecins Sans Frontieres' medical unit in South
Africa, said there are no signs that drug resistance is
developing more quickly in Africa than elsewhere. Ford
was not involved in the study.
He and others
said developing countries should still work on making lab
services a standard part of HIV care.
accept that this is too complicated and expensive and we
need to do without it,'' Ford said.
''In an ideal
world, you would want lab support everywhere,'' said AIDS
expert Gilks. ''But right now we need to continue to roll
out the medicines because that is what's going to save
lives.'' (Maria Cheng, AP)