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Infectious Disorders - Drug Targets

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ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

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Research Article

Utility of CD4 Cell Count and Viral Load Assay in Hospitalized Patients with Known HIV Infection: High Value Care Exercise

Author(s): Amos Lal and George M. Abraham*

Volume 20, Issue 4, 2020

Page: [486 - 490] Pages: 5

DOI: 10.2174/1871526519666191011162018

Price: $65

Abstract

Purpose: Healthcare spending as a percentage of Gross domestic product (GDP) is at all-time high and continues to rise in the United States. The Centers for Medicare and Medicaid Services estimate that 33% of resources spent on healthcare goes to waste. As part of a ‘high value care’ exercise, we studied if estimating CD4 cell counts and HIV viral load in hospitalized patients with a known diagnosis of HIV led to any meaningful change in HAART regimen and discharge diagnosis.

Methods: Retrospective chart review for all patients admitted with a known diagnosis of HIV from January 1, through December 31, 2017.

Results: A total of 83 patient encounters were reviewed during the period. The mean age was 54.1 ± 16.4 years, 64.1 % of patients were males. 75 patients (90.3%) were already on highly active antiretroviral therapy (HAART). The median hospital length of stay (LOS) was 3 days (IQR 2.0 - 5.0). The mean turnaround time for CD4 counts and HIV viral load assay was 2.9 days (95% CI 2.1 – 3.7) and 3.9 days (95% CI, 3.2 – 4.6), respectively. A CD4 count estimation led to no change in HAART regimen. HIV viral load assay testing had no impact on a change in treatment or a change in diagnosis.

Conclusions: In our study, testing CD4 counts and HIV viral load for inpatients did not confer any benefit in altering the diagnosis or HAART regimen. We believe that our study identifies a systems level opportunity to add to the concept of ‘Choosing Wisely.’

Keywords: High value care, choosing wisely, HIV, CD4, Viral load, laboratory test, antibiotics.

[1]
http://www.choosingwisely.org/getting-started/resourcelibrary/research-report/PhiladelphiaPA 19106: American College of Physicians, 2016 [cited 2019 March]; Available from:, http://www.choosingwisely.org/getting-started/resource-library/research-report/
[2]
Iams, W.; Heck, J.; Kapp, M.; Leverenz, D.; Vella, M.; Szentirmai, E.; Valerio-Navarrete, I.; Theobald, C.; Goggins, K.; Flemmons, K.; Sponsler, K.; Penrod, C.; Kleinholz, P.; Brady, D.; Kripalani, S. A Multidisciplinary Housestaff-Led Initiative to Safely Reduce Daily Laboratory Testing. Acad. Med., 2016, 91(6), 813-820.
[http://dx.doi.org/10.1097/ACM.0000000000001149] [PMID: 27028031]
[3]
Kost, A.; Genao, I.; Lee, J.W.; Smith, S.R. Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely. J. Am. Board Fam. Med., 2015, 28(4), 471-474.
[http://dx.doi.org/10.3122/jabfm.2015.05.140332] [PMID: 26152437]
[4]
Larochelle, M.R.; Knight, A.M.; Pantle, H.; Riedel, S.; Trost, J.C. Reducing excess cardiac biomarker testing at an academic medical center. J. Gen. Intern. Med., 2014, 29(11), 1468-1474.
[http://dx.doi.org/10.1007/s11606-014-2919-5] [PMID: 24973056]
[5]
Matulis, J; Liu, S; Mecchella, J; North, F; Holmes, A. Choosing Wisely: A Quality Improvement Initiative to Decrease Unnecessary Preoperative Testing. BMJ Quality Improvement Reports., 2017, 6(1), bmjqir.u216281.w6691. http://dx.doi.org/10.1136/bmjquality.u216281.w6691
[6]
Stinnett-Donnelly, J.M.; Stevens, P.G.; Hood, V.L. Developing a high value care programme from the bottom up: a programme of faculty-resident improvement projects targeting harmful or unnecessary care. BMJ Qual. Saf., 2016, 25(11), 901-908.
[http://dx.doi.org/10.1136/bmjqs-2015-004546] [PMID: 26700543]
[7]
Raja, A.S.; Venkatesh, A.K.; Mick, N.; Zabbo, C.P.; Hasegawa, K.; Espinola, J.A.; Bittner, J.C.; Camargo, C.A., Jr “Choosing Wisely” Imaging Recommendations: Initial Implementation in New England Emergency Departments. West. J. Emerg. Med., 2017, 18(3), 454-458.
[http://dx.doi.org/10.5811/westjem.2017.1.32677] [PMID: 28435496]
[8]
Pham, M.D.; Romero, L.; Parnell, B.; Anderson, D.A.; Crowe, S.M.; Luchters, S. Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review. AIDS Res. Ther., 2017, 14(1), 3.
[http://dx.doi.org/10.1186/s12981-017-0131-5] [PMID: 28103895]
[9]
Sax, P.E. Editorial commentary: can we break the habit of routine CD4 monitoring in HIV care? Clin. Infect. Dis., 2013, 56(9), 1344-1346.
[http://dx.doi.org/10.1093/cid/cit008] [PMID: 23315314]
[10]
Gale, H.B.; Gitterman, S.R.; Hoffman, H.J.; Gordin, F.M.; Benator, D.A.; Labriola, A.M.; Kan, V.L. Is frequent CD4+ T-lymphocyte count monitoring necessary for persons with counts >=300 cells/μL and HIV-1 suppression? Clin. Infect. Dis., 2013, 56(9), 1340-1343.
[http://dx.doi.org/10.1093/cid/cit004] [PMID: 23315315]
[11]
Whitlock, G.G.; Ahmed, N.; Benn, P.; Edwards, S.; Waters, L. Stop routine CD4 monitoring in HIV-infected patients with fully suppressed virus and CD4 >=350 cells/ml. Clin. Infect. Dis., 2013, 57(2), 327-328.
[http://dx.doi.org/10.1093/cid/cit203] [PMID: 23537910]
[12]
Salvant Valentine, S.; Poulin, A. Consistency of State Statutes and Regulations With Centers for Disease Control and Prevention’s 2006 Perinatal HIV Testing Recommendations. Public Health Rep., 2018, 133(5), 601-605.
[http://dx.doi.org/10.1177/0033354918792540] [PMID: 30096022]
[13]
Laurence, J. T-cell subsets in health, infectious disease, and idiopathic CD4+ T lymphocytopenia. Ann. Intern. Med., 1993, 119(1), 55-62.
[http://dx.doi.org/10.7326/0003-4819-119-1-199307010-00010] [PMID: 8098929]
[14]
Laurence, J. HIV therapeutics: points from the recent literature. AIDS Read., 2003, 13(7), 305-307.
[15]
Aldrich, J.; Gross, R.; Adler, M.; King, K.; MacGregor, R.R.; Gluckman, S.J. The effect of acute severe illness on CD4+ lymphocyte counts in nonimmunocompromised patients. Arch. Intern. Med., 2000, 160(5), 715-716.
[http://dx.doi.org/10.1001/archinte.160.5.715] [PMID: 10724063]
[16]
Schackman, B.R.; Gebo, K.A.; Walensky, R.P.; Losina, E.; Muccio, T.; Sax, P.E.; Weinstein, M.C.; Seage, G.R., III; Moore, R.D.; Freedberg, K.A. The lifetime cost of current human immunodeficiency virus care in the United States. Med. Care, 2006, 44(11), 990-997.
[http://dx.doi.org/10.1097/01.mlr.0000228021.89490.2a] [PMID: 17063130]
[17]
Schackman, B.R.; Fleishman, J.A.; Su, A.E.; Berkowitz, B.K.; Moore, R.D.; Walensky, R.P.; Becker, J.E.; Voss, C.; Paltiel, A.D.; Weinstein, M.C.; Freedberg, K.A.; Gebo, K.A.; Losina, E. The lifetime medical cost savings from preventing HIV in the United States. Med. Care, 2015, 53(4), 293-301.
[http://dx.doi.org/10.1097/MLR.0000000000000308] [PMID: 25710311]
[18]
Di Biagio, A.; Ameri, M.; Sirello, D.; Cenderello, G.; Di Bella, E.; Taramasso, L.; Giannini, B.; Giacomini, M.; Viscoli, C.; Cassola, G.; Montefiori, M. Is it still worthwhile to perform quarterly cd4+ t lymphocyte cell counts on hiv-1 infected stable patients? BMC Infect. Dis., 2017, 17(1), 127.
[http://dx.doi.org/10.1186/s12879-017-2199-x] [PMID: 28166729]
[19]
Walker, A.S.; Gibb, D.M. Monitoring of highly active antiretroviral therapy in HIV infection. Curr. Opin. Infect. Dis., 2011, 24(1), 27-33.
[http://dx.doi.org/10.1097/QCO.0b013e3283423e0e] [PMID: 21150591]
[20]
Callen, J.; Georgiou, A.; Li, J.; Westbrook, J.I. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual. Saf., 2011, 20(2), 194-199.
[http://dx.doi.org/10.1136/bmjqs.2010.044339] [PMID: 21300992]
[21]
Plebani, M. Defensive medicine and diagnostic testing. Diagnosis (Berl.), 2014, 1(2), 151-154.
[http://dx.doi.org/10.1515/dx-2014-0002] [PMID: 29539997]

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