Frequency of VL/CD4 counts

Question

Hello Dr, I am currently on triumeq (and many antibiotics as prophylaxis) with an UD viral load and a low CD4 of 64 which has been slowly rising. When I first started treatment in October 2015, my HIV doctor wanted me to do bloodwork every month since I had a high viral load of 108,000, a CD4 of 20 and put on many antibiotics in addition to trimeq. Now that I am UD, my doctor says monthly checks are not necessary and that every 3 months or 4x a year is ok since I am feeling good, put all my weight back on and now just waiting for my cd4 to go up. So my question is when does it happen that I will only need to do VL/CD4 twice a year or even once a year? When my CD4 is above 200? What happens if I don't do my labs exactly every three months? THanks, J

Answer

The recommended frequency of surrogate marker lab testing in HIV patients doing OK on treatment (suppressed viral levels) has been decreasing. For patients with suppressed HIV levels checking every 6 months is reasonable. Once the CD4 count is > 200-350 checking that level every 6 months is also reasonable in the setting of suppressed HIV levels (that is key marker for success of regimen). Once the CD4 count > 500 then checking the level yearly or even less often is current recommendation (again in the setting of suppressed HIV level).KH