Monitoring of highly active antiretroviral therapy in HIV infection.
PURPOSE OF REVIEW: Patients on antiretroviral therapy (ART) in high-income countries have routine laboratory tests to monitor ART efficacy/toxicity. We review studies describing the outcomes and costs of different monitoring approaches, predominantly in low-income countries. RECENT FINDINGS: CD4 cel...
| Main Authors: | , |
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| Format: | Journal article |
| Language: | English |
| Published: |
2011
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| _version_ | 1826287434050043904 |
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| author | Walker, A Gibb, D |
| author_facet | Walker, A Gibb, D |
| author_sort | Walker, A |
| collection | OXFORD |
| description | PURPOSE OF REVIEW: Patients on antiretroviral therapy (ART) in high-income countries have routine laboratory tests to monitor ART efficacy/toxicity. We review studies describing the outcomes and costs of different monitoring approaches, predominantly in low-income countries. RECENT FINDINGS: CD4 cell counts, HIV RNA viral load and clinical events are frequently discordant; viral load suppression occurs with WHO-defined CD4 failure and, as expected, viral load failure often occurs before CD4 failure. Routine CD4 monitoring provides small but significant mortality/morbidity benefits over clinical monitoring, but, at current prices, is not yet cost-effective in many sub-Saharan African countries. Viral load monitoring is less cost-effective with modelling studies reporting variable results. More research into point-of-care tests, methods for targeting monitoring and thresholds for defining failure is needed. Most laboratory monitoring for toxicity is neither effective nor cost-effective. In terms of models for delivery of care, task-shifting with nurse-led and decentralized care appear as effective as doctor-led or centralized care. SUMMARY: Recent studies have improved the evidence base for monitoring on ART. Future research to increase cost-effectiveness by better targeting of monitoring and/or evaluating implementation of less costly point-of-care tests will contribute to long-term success of ART while continuing to increase ART coverage. |
| first_indexed | 2024-03-07T01:58:36Z |
| format | Journal article |
| id | oxford-uuid:9c961403-ec16-4ac6-b7bd-d58d0d15f7ca |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T01:58:36Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:9c961403-ec16-4ac6-b7bd-d58d0d15f7ca2022-03-27T00:37:01ZMonitoring of highly active antiretroviral therapy in HIV infection.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9c961403-ec16-4ac6-b7bd-d58d0d15f7caEnglishSymplectic Elements at Oxford2011Walker, AGibb, DPURPOSE OF REVIEW: Patients on antiretroviral therapy (ART) in high-income countries have routine laboratory tests to monitor ART efficacy/toxicity. We review studies describing the outcomes and costs of different monitoring approaches, predominantly in low-income countries. RECENT FINDINGS: CD4 cell counts, HIV RNA viral load and clinical events are frequently discordant; viral load suppression occurs with WHO-defined CD4 failure and, as expected, viral load failure often occurs before CD4 failure. Routine CD4 monitoring provides small but significant mortality/morbidity benefits over clinical monitoring, but, at current prices, is not yet cost-effective in many sub-Saharan African countries. Viral load monitoring is less cost-effective with modelling studies reporting variable results. More research into point-of-care tests, methods for targeting monitoring and thresholds for defining failure is needed. Most laboratory monitoring for toxicity is neither effective nor cost-effective. In terms of models for delivery of care, task-shifting with nurse-led and decentralized care appear as effective as doctor-led or centralized care. SUMMARY: Recent studies have improved the evidence base for monitoring on ART. Future research to increase cost-effectiveness by better targeting of monitoring and/or evaluating implementation of less costly point-of-care tests will contribute to long-term success of ART while continuing to increase ART coverage. |
| spellingShingle | Walker, A Gibb, D Monitoring of highly active antiretroviral therapy in HIV infection. |
| title | Monitoring of highly active antiretroviral therapy in HIV infection. |
| title_full | Monitoring of highly active antiretroviral therapy in HIV infection. |
| title_fullStr | Monitoring of highly active antiretroviral therapy in HIV infection. |
| title_full_unstemmed | Monitoring of highly active antiretroviral therapy in HIV infection. |
| title_short | Monitoring of highly active antiretroviral therapy in HIV infection. |
| title_sort | monitoring of highly active antiretroviral therapy in hiv infection |
| work_keys_str_mv | AT walkera monitoringofhighlyactiveantiretroviraltherapyinhivinfection AT gibbd monitoringofhighlyactiveantiretroviraltherapyinhivinfection |