Routine Laboratory Monitoring Not Essential for Implementation of First-Line ART in Africa

With drastic reductions in the price of antiretroviral drugs, laboratory tests have become one of the largest contributors to the cost of providing antiretroviral therapy (ART) in resource-constrained settings. This expense, coupled with the lack of laboratory facilities, has resulted in patients on ART being managed without routine laboratory monitoring.

To evaluate the consequences of this approach, investigators conducted an open, noninferiority trial (DART) among 3321 symptomatic HIV-infected adults initiating ART in Uganda and Zimbabwe (median CD4 count, 65 cells/mm³). Patients were randomized to clinical monitoring with or without additional routine toxicity and CD4-cell–count monitoring.

Five-year survival was similar between the group…