[pronut-hiv] Africa: Weight Loss And Fever As Telling As Lab Tests

["ProNut-HIV" <pronut-hiv@healthnet.org>]

The East African ( http://www.nationmedia.com/eastafrican/current/ )
(Nairobi)
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.

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.