Going 4 or 6 months between office
visits instead of the standard 3 does not appear to compromise virologic
control among stable HIV-infected patients, researchers suggested here.
After 12 months, 75% of the HIV
patients who saw their doctors on a 3-month interval maintained virologic
control, said April Buscher, MD, an attending physician at Durham VA Medical
Center in North Carolina.
If patients only saw their
physicians every 4 months, 75% still had undetectable viral loads at the end of
a year. If the patients only saw their doctors twice a year – every 6 months --
at the end of 12 months 76% had maintained virologic control, Buscher reported
at her poster presentation at IDWeek.
"Our data show that
participants who were scheduled a next HIV primary care clinic visit in 4
months or in 6 months were not at increased risk of virologic failure at 12
months compared with persons with a follow-up scheduled at 3 months," she
told MedPage Today.
She said that reduced office visits
mean lower costs for patients, less time dealing with their illness, and less
disruption of regular activities – without a loss of virologic control.
Buscher performed the study while a
resident at Baylor College of Medicine in Houston, and covered six different
clinic sites. She and her colleagues performed a retrospective cohort study of
HIV-infected persons, eventually identifying 1,512 men and 653 women for the
study.
The participants averaged about 47
years old; 21% were white, 58% were black and 22% were Hispanic. All the
patients had an undetectable viral load at baseline, and then were assessed 12
months later.
"A three-month interval for the
office visit and for testing is the standard of care for patients with HIV
infection," Buscher said.
In her study, 1,429 patients were
seen every 3 months. Another 574 patients had office visits scheduled every 4
months, and 168 patients had office visits scheduled every 6 months. She
suggested that the small number of patients with 6-month visits might limit the
generalizability of her findings for that group.
In their analysis, Buscher and
colleagues observed that patients who missed or cancelled visits or had
CD4-positive cells counts below 200 cells/mm3 were more likely to experience
virologic failure – detectable HIV in the blood using the 400 copies/ml assay.
"This is one of the first
studies that has looked at outcomes among patients who canceled
appointments," Buscher said. She found that 71% of patients who canceled
an appointment maintained virologic control at 1 year, compared with 81% of
patients who kept their appointments."
She suggested that seeing patients
less often than every 6 months might make it more problematic dealing with
other comorbidities that occur in aging populations – including heart disease,
hypertension, and obesity -- so that yearly visits, for example, might not be
beneficial.
Meghan Rothenberger, MD, assistant
professor of medicine at the University of Minnesota, Minneapolis, told MedPage
Today, "In my HIV clinic I have patients that I am very comfortable in
seeing every 6 months."
But Rothenberger added that there
are others for whom -- for reasons unrelated to HIV -- there is concern about
adherence. "So there are some patients who I want to see more often and
every 3 months is a good interval for them." Rothenberger did not
participate in Buscher's study.
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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