HIV Medicine Association has released recommendations on commonly ordered, but not always necessary tests and procedures, to help patients and medical providers make the most of healthcare opportunities and resources, as part of the ABIM Foundation’s Choosing Wisely® campaign. The five recommendations serve as a starting point for conversations between patients and their providers about evidence-based care.
Developed through input from specialists in HIV care, and the most recent recommendations for HIV management, HIVMA has identified five tests that physicians and patients should question:
- Avoid unnecessary CD4 tests – CD4 monitoring is not necessary for patients who have stable viral suppression. For the first two years after treatment initiation, the CD4 count should be monitored every three to six months. After two years, if the viral load is undetectable, the CD4 count should be measured yearly if it is 300-500 cells/mm3. If it is consistently above >500 cells/mm3 then further monitoring is optional.
- Don’t order complex lymphocyte panels when ordering CD4 counts – Order only CD4 counts and percentages rather than ordering other lymphocyte panels.
- Avoid quarterly viral load testing of patients who have durable viral suppression, unless clinically indicated – Viral load testing should be conducted before initiation of treatment, two to eight weeks after initiation or modification of therapy, and then every three to four months to confirm continuous viral suppression. In clinically stable patients who have durable virological suppression for more than two years, clinicians may extend the interval to six months.
- Don’t routinely order testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency for patients who are not predisposed due to race/ethnicity – G6PD deficiency testing is recommended upon entry into care or before starting therapy with an oxidant drug only in HIV-infected patients who are predisposed to this genetic disorder that can cause hemolytic anemia. G6PD most frequently occurs in populations of African, Asian and Mediterranean descent and is most likely to affect HIV-infected patients with one of these racial or ethnic backgrounds.
- Don’t routinely test for Cytomegalovirus (CMV) lgG in HIV-infected patients who have a high likelihood of being infected with CMV – Cytomegalovirus (CMV) IgG testing is recommended only in patients who are at lower risk for CMV to detect latent CMV infection. CMV IgG testing is not necessary in patients at higher risk for CMV, because they can be assumed to be CMV positive. Testing for CMV antibody in low-risk populations is recommended to foster patient counseling in avoidance of CMV infection through practicing safe sex and to avoid transfusion except with CMV-negative blood products. Patients at lower risk for CMV infection should be tested for latent CMV infection with an anti-CMV IgG upon initiation of care.
“Providing high quality care to our patients also means not ordering unnecessary tests. Implementing these principles in our practice will save money by avoiding unnecessary tests,” HIVMA Chair Dr. Carlos del Rio said.
Launched in 2012, the Choosing Wisely campaign continues to be widely recognized across the U.S. health care system as a leading effort to encourage conversations between patients and clinicians about what care is truly necessary. More than 70 medical specialty societies are partners in the effort and have collectively identified more than 400 tests and treatments they say are overused in their specialty. Consumer Reports, a partner in the Choosing Wisely, leads efforts to develop patient-friendly materials based on society recommendations and disseminates them broadly to consumers through their network of partners.
For details on each recommendation, please visit http://www.choosingwisely.org/societies/hiv-medicine-association/..