A Randomized Study of the Utility of Human Immunodeficiency Virus RNA Measurement for the Management of Antiretroviral Therapy [Haubrich RH et al. CID 2001;33:1060] This is a report from the California Collaborative Treatment Group 570 team to determine the utility of a clinical strategy for monitoring viral load at frequent intervals in patients with CD4 cell counts <500. There were 206 participants who were randomized to receive viral load testing at baseline and every two months vs. baseline and twice yearly. Participants had unrestricted antiretroviral therapy. The results at six months showed that HIV RNA reduction averaged 0.9 log₁₀ c/mL with frequent monitoring compared with 0.5 log₁₀ c/mL with infrequent monitoring (p=0.0002). The authors conclude that there is better virologic response with HIV RNA measurements that are more frequent than is currently recommended. Other observations favoring the frequent viral load monitoring group were a higher CD4 cell count response (91 cells/mm³ vs. 75 cells/mm³ at month 8), the number with undetectable virus (36% vs. 22% at month 8), and fewer deaths (5 vs. 8); the median number of changes in antiretroviral regimen/year was similar for the two groups, and adherence according to a questionnaire was not significantly different.
Comment: This is an interesting report that addresses the issue of strategies for monitoring HAART. The current recommendation is to measure viral load at 3-4 month intervals, although many have suggested that more frequent monitoring is probably appropriate when patients initiate antiretroviral therapy or change their regimen. This report is unfortunate in the sense that it concludes that current recommendations are for viral load monitoring at 3-4 month intervals, which really applies only to patients in a stable state, and the control group in their study was monitored only at 6-month intervals, which is not recommended by anyone. Nevertheless, the advantage of frequent monitoring and its impact on outcome is an important message.
posted 10/9/2001

back to news table of contents