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Necessity to do Viral Loads before Rxing a Protease Inhibitor
Jan 6, 1997

Viral Load testing is very expensive, therefore a number of persons unable to pay or not in a position to make certain free decissions about there health care are not getting perscribed Protease Inhibitors due to the cost factor of the test. Is it absolutly necessary to do Viral Load testing before prescribing a Protease Inhibitor? If so, a baseline is done and then how often is repeat Viral Load testing required or suggested. If not, what are the indicators that a Physician should use to determine when a patient would benefit from a Protease Inhibitor? I am trying to find a way around company red tape and get these patients what they need and still keep my job. A difficult task. But I was taught a patients well being and quality of life comes first . I didn't enter the Healthcare profession to save a company money by short changing the patient. Please Help!!

Response from Dr. Cohen

I'm glad you're concerned about this issue. Let me try to give you some ammunition to further your cause.

A viral load is about $200, max. If done four times per year, that's $800. Protease inhibitors run around $5000 - $7000 per year. The cost of the viral load is small in comparison. Furthermore, viral loads are now FDA-approved tests, so insurance companies should be paying for them.

Besides, to look at it from the company's perspective, you could say that doing viral loads will SAVE money. Now, I hate to even suggest this, because I believe the decision to use a protease inhibitor should not be based strictly on viral load. But if you performed the test and found that a viral load was only 15,000, you might feel more comfortable using nucleosides or nucleosides plus NNRTIs and holding off on protease inhibitors. Without the test you wouldn't have known that a less aggressive and less expensive combination would have been adequate. In other cases, the viral load may be so low without treatment that you and the patient may decide to defer treatment altogether. Once again, the test would have saved money.

Viral load measurement is usually performed at three month intervals, along with a CD4 count. It is also recommended that it be measured after four to six weeks on a new antiretroviral regimen.

Viral load measurement is considered STANDARD OF CARE in the management of HIV infection. It is no longer considered acceptable practice to withhold this test.

New HIV+, Vaccines, Viral Load, AZT/3TC
Possibly low cd4 - need to test for HIV?

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