How will new guidelines affect CD4 testing in veterans with HIV?

Abstract

Background. Guidelines now recommend limited use of routine CD4 cell count testing in human immunodeficiency virus (HIV)-infected patients with successful viral control who are not immunocompromised. Methods. CD4 and viral load tests for patients receiving HIV care from the US Department of Veterans Affairs during 2009-2013 were evaluated to determine trends inCD4 testing frequency and the number, cost, and results ofCD4 tests considered optional under the guidelines. Results. Therewere 28 530 individuals with sufficient testing to be included. At the time of the last CD4 test, 19.8%of the cohort was eligible for optionalmonitoring and 15.6% forminimalmonitoring. CD4 testing frequency declined by 10.8% over 4 years, reducing the direct cost of testing by US$196 000 per year. Full implementation of new treatment guidelines could reduce CD4 testing a further 28.9%, an additional annual savings of US$600 000. CD4 tests conducted during periods of potentially reduced monitoring were rarely <200 cells/μL: 1.1%of the tests conducted when minimal monitoring was recommended and just 0.3%of tests conducted when optional monitoring was recommended were less than this value. Conclusions. Reduced CD4 monitoring of HIV-infected patients would result in modest cost savings and likely reduce patient anxiety, with little or no impact on the quality of care. Veterans Affairs has made substantial progress in reducing the frequency of optional CD4 testing, but further reductions may still be warranted.