Recently, there has been a move to people who are doing well on HIV treatment having their viral load and CD4 counts monitored less frequently. A large observational study, looking at data from almost 40,000 people from Europe and the United States, has looked into this issue. The researchers examined the results of people who began HIV treatment and who had an undetectable viral load within a year.

After this point, their CD4 and viral load was monitored according to one of three strategies:

  • every three months
  • every six months
  • every nine to twelve months.

Two years later, there were no differences in the most important clinical outcomes – AIDS-related illnesses or deaths. These events were rare but were spread evenly between the groups.

The researchers then looked at people having a sustained increase in viral load above 200 copies/ml, in other words ‘virological failure’. People who had monitoring every six months were no more likely to have this happen than people with monitoring every three months. The researchers concluded that the frequency of monitoring for people with an undetectable viral load can be safely reduced from every three months to every six months.

As a result, proposed new guidelines from the British HIV Association suggest that, once people have had an undetectable viral load for at least a year, their viral load should be checked every three to six months, but their CD4 count no longer needs to be monitored. But if their viral load increased, or they had HIV-related symptoms, then the CD4 count would be monitored again.

You can find out more on this issue in NAM’s booklet ‘CD4, viral load & other tests’.