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Africa: Weight Loss And Fever As Telling As Lab Tests
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The East African (Nairobi)
5 May 2008
Posted to the web 5 May 2008
Philip Ngunjiri
Nairobi
CLINICIANS TREATING MILlions of people living with HIV/Aids in poor countries in Africa and Asia can now rest assured that simple signs of deteriorating health such as weight loss or fever are almost as effective as advanced laboratory tests.
This is according to a new United Nations-backed paper.
The results of the study, published in the current issue of the Lancet, show that clinicians treating HIV-infected people without relying on laboratory tests are not compromising their patients' safety, according to Charles Gilks, co-ordinator of anti-retroviral treatment and HIV care at the UN World Health Organisation and co-author of the study.
"In fact, the outcome of their treatment is almost as good as for those patients in the US and Europe where laboratory-guided treatment is the norm," he said.
The aim of the study was to look at the medium and long-term consequences of different approaches to monitoring anti-retroviral therapy in a resource-limited setting: Using clinical signs and symptoms alone as recommended in WHO guidelines; or more sophisticated and costly but far less accessible immunological and virological load tests.
The scientists used a model that had been tried and tested in London, and shown to accurately predict the course of the epidemic in the UK over 20 years, but with various changes to reflect realities on the ground.
According to the study authors, survival rates for individuals assessed for clinical symptoms alone were almost identical to those who underwent laboratory monitoring.
The five-year survival rate was 83 per cent for individuals monitored for viral load, 82 per cent for CD4 count monitoring (a critical immune component) and 82 per cent for clinical monitoring alone.
ALTHOUGH THE SURVIVAL rate was slightly higher with viral load monitoring, study authors pointed out it was not the most cost-effective strategy for those in the poorest countries.
The study also examined whether clinical observation alone was effective in determining when to switch patients from WHO-recommended first-line treatments to more costly second-line medicines.
Again, diagnosis based on an assessment of clinical symptoms was almost as effective as those relying on expensive laboratory tests.
Study authors concluded that, for patients on the WHO first-line regimen of stavudine, lamivudine and nevirapine, the benefits of CD4 count or viral load monitoring were only modest at best.
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The study, by a prominent group in the United Kingdom working with WHO scientists, employs mathematical models designed to identify emerging problems and problems that might appear after long-term use of ART.
The study is based on mathematical projections and not on real world patients. While there is little real world data yet available, because these drugs have been used for such a short time in these countries, the little existing information does support the findings.
Other studies are ongoing. Africa is without a doubt the region most affected by the virus. Inhabited by just over 12 per cent of the world's population, Africa is estimated to have more than 60 per cent of the HIV-infected population.
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