Clinical monitoring alone a viable means to increase ART in resource-limited settings

BOSTON — Despite the WHO recommendation for laboratory monitoring of antiretroviral therapy, clinical monitoring alone may increase adherence to therapy in resource-limited settings when accounting for budgetary constraints, according to a speaker here.

Charles Kouanfack, MD, of Central Hospital in Yaoundé, Cameroon, and colleagues set out to compare the safety and efficacy of clinical monitoring alone (n=238) and clinical plus laboratory monitoring (n=221) in ART-naive HIV-positive adults across nine hospitals in Cameroon.

Mean increase in CD4 cell count for those assigned clinical monitoring alone was 175 cells/mcL when compared with 206 cells/mcL among those assigned clinical plus laboratory monitoring.

However, 6% of patients assigned clinical plus laboratory monitoring switched to second-line therapy due to treatment failure vs. no participants in the clinical monitoring alone group (P<.001).

Conversely, similarities were observed between those assigned clinical monitoring alone and clinical plus laboratory monitoring for adherence (64% for both), viral suppression (49% vs. 52%), disease progression (36% vs. 29%), toxicity (19% vs. 25%), mortality (18% vs. 14%) and HIV-resistance (10% for both).

“Failure to demonstrate the non-inferiority of immunological recovery and to detect the need of switching to second-line treatment with clinical monitoring alone support the WHO recommendations for laboratory monitoring in ART when possible in order to improve quality of HIV care,” Kouanfack said. “This finding underlines the need to develop simple and affordable point of care or alternative methods for biological monitoring to preserve a future.” – by Jennifer Henry

For more information:

• Kouanfack. #45LB. Presented at: 18th Conference on Retroviruses and Opportunistic Infections; Feb. 27-March 3, 2011; Boston.

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