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 on Friday.

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.”

By Stephanie Nebehay
GENEVA (Reuters)