hysical Checks for AIDS Nearly As Good As Lab Tests

AIDS patients in poor countries checked for signs of decline such as fever
or weight loss are likely to have nearly the same survival rate as Western
patients who undergo costly laboratory tests, researchers said.
Observing clinical symptoms is also almost as effective as laboratory
analysis in deciding when to switch from first-line drug treatments to
second-line drugs if resistance sets in, according to the study in the
Lancet medical journal.
Doctors in poor countries, especially in Africa, often rely on physical
signs alone to track progression of the deadly disease. There are about 2
million people in developing countries taking life-extending HIV drugs.
Few of those patients have access to costly tests to measure the body's
immune levels by measuring how much virus is traveling in the bloodstream or
by counting the numbers of immune cells called CD4 T-cells, which are
standard in rich countries.
HIV infection is incurable but drug cocktails can help keep patients alive
and healthy. These are usually started based on measures of how far along
the infection has progressed.
The study suggests it is alright to make these assessments based on the
patient's health rather than using the more expensive blood tests.
"Our results suggest that use of antiretroviral therapy without monitoring
of viral load or CD4 cell count does not have marked detrimental effects on
patient survival or on development of resistance," the researchers wrote.
Access to AIDS drugs should be expanded to all regions hit by the epidemic
as soon as possible, they said. "Lack of access to laboratory monitoring
should not be allowed to hinder this process."

REASSURING CLINICIANS
The team, led by Andrew Philipps of University College London, included Dr.
Charles Gilks, coordinator of antiretroviral treatment and HIV care at the
World Health Organization (WHO).
"The results of this study should reassure clinicians in Africa and Asia,
who are treating literally millions of people without these laboratory
tests, that they are not compromising patient safety," co-author Gilks said
in a statement issued by the Geneva-based WHO.
"In fact, the outcome of their treatment is almost as good as those patients
in the United States and Europe where laboratory-guided treatment is the
norm," he added.
AIDS has killed 25 million people globally and currently infects 33 million.
The study published in The Lancet was based on mathematical projections
using a computer simulation model of HIV infection, not on actual patients.
The percentage of patients surviving 5 years was predicted to be roughly the
same in each case -- at 83 percent in patients using the viral load
monitoring strategy, 82 percent from CD4 cell count monitor and 82 percent
with clinical monitoring.
Over a 20-year period, the projected survival rates with the three methods
were 67, 64 and 64 percent respectively.
The WHO, a United Nations agency, is working to ensure that all 7 million
people in low-and middle income-countries get access to antiretroviral
drugs.
"We're not saying don't do the tests because they obviously do help but if
you don't have tests available, the priority remains to get drugs there in
the first instance," Gilks told Reuters. "Drugs are the most important thing
because without them people die, it is as simple as that." [RT]