Monitoring Patients for ART Failure in Resource-Limited Settings

In resource-limited settings, the value of viral loads and CD4-cell counts for monitoring the progress of HIV-infected patients before and after the initiation of antiretroviral therapy (ART) remains controversial. On the one hand, recent cost-effectiveness studies favor CD4-cell monitoring over clinical observation alone, even in some of the poorest nations (N Engl J Med 2006; 355:1141). On the other hand, current WHO guidelines recommend that clinically eligible patients receive HIV therapies, regardless of whether concomitant laboratory monitoring can be provided.

To inform this debate, investigators constructed a computer simulation model that evaluated how three different types of monitoring for antiretroviral failure might influence ou…