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Concerned with HIV Testing and Monitoring in Developing countries.
Dec 26, 2006

Benjamin

Thanks for your effort and dedication that you and your team have demonstrated in helping us. We always marvel the information you share with us.

Hey Benjamin a friend of mine is HIV+ and discovered this mid last year. Early this year her results came back a CD4 of more than 300, its just that i cant remember the exact number and the percentage was 28. recent numbers(last week)came back with a CD4=205 and percentage=22%. Our concern is that she looking well. In fact we are not disputing the current status but she has not done any viral load test to detect the amount of virus.Moreover, i hope you are aware the VL and the confirmatory tests are very expensive in developing countries. The point im trying to arrive is that now they told her to consider starting treatment soon. In the absence the VL numbers, do you agree with this view? Is it enough to start treatment based on CD4 numbers only? More often you advise people not to rely much on the CD4 without the VL numbers, because of its volatility and the fact CD4 can react to many factors. She is now unsure whether to start treatment or get another numbers to support the current numbers. We bank on you guys because our doctors in other countries are not so much exposed like you. So we need your advice, should she start treatment or try to have VL test done before treatment begins.

I hope this is not too much

Response from Dr. Young

Thank you for your post.

In resource-limited countries, the standards for laboratory monitoring of HIV infection may differ significantly from the US or Europe.

As you point out HIV viral load tests can be considerably more expensive to obtain than CD4 counts. For example in Russia, where I just was, a viral load may cost about $100 USD whereas a CD4 count is only about $25. In such settings, where monies spent on viral loads may take monies away from antiretroviral medications, the choice is simple.

Indeed, even CD4 counts may not be required to start treatment- and HIV treaters will base the decision to start medications on clinical grounds or active AIDS complications (using WHO criteria, for example).

With your friends most recent CD4 count approaching 200, most HIV treaters would probably suggest starting antiretroviral therapy, irrespective of country-- especially if she has had any HIV-related symptoms. Depending on the availability and cost of the CD4 count test, if there's any lingering doubt about the lab test, then a repeat test may help add to the decision making. A viral load test probably wouldn't change this opinion, irrespective of what viral load result was obtained.

I hope this delayed response is of value to you and your friend. Best of health to both of you in the new year. BY



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