Routine laboratory monitoring improves health and survival compared with clinical monitoring of HIV patients in Uganda

This study evaluated the use of routine laboratory monitoring in terms of clinical outcomes among patients receiving antiretroviral therapy (ART) in Uganda using a randomised clinical trial in a home-based ART programme in rural Uganda.

All participants were people with HIV who were members of the AIDS Support Organisation. Participants had CD4 cell counts <250 cells × 106 /l.

Participants were randomised to one of three different monitoring arms: a viral load arm (clinical monitoring, quarterly CD4 counts, and viral load measurements), CD4 arm (clinical monitoring and CD4 counts), or clinical arm (clinical monitoring alone). The main outcome measures were serious morbidity (newly diagnosed AIDS-defining illness) and mortality.

A total of 1 094 participants started ART; median CD4 count at baseline was 129 cells × 106 /l. Median follow-up was three years. In total, 126 participants died (12%), 148 (14%) experienced new AIDS-defining illnesses, and 61(6%) experienced virological failure, defined as two consecutive viral loads >500 copies/ml occurring more than three months after the start of ART. After adjustment for age, sex, baseline CD4 count, viral load, and body mass index, the rate of new AIDS-defining events or death was higher in the clinical arm than the viral load arm (adjusted hazard ratio 1.83, p=0.002) or the CD4 arm (1.49, p=0.032). There was no significant difference between the CD4 arm and the viral load arm (1.23, p=0.31).

In patients receiving ART for HIV infection in Uganda, routine laboratory monitoring is associated with improved health and survival compared with clinical monitoring alone.

Mermin J, et al. BMJ 2011; 343 doi: 10.1136/bmj.d6792 (published 9 November 2011). Cite this as: BMJ 2011;343:d6792.

Bridget Farha m

ugqirha@iafrica.com