Choosing Wisely:

Avoid unnecessary CD4 tests.

Rationale and Comments: A CD4 count is not required in conjunction with every viral load test. Viral load testing is a better indicator of a patient’s response to therapy. 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.
Sponsoring Organizations:
  • HIV Medicine Association
  • Sources:
  • IDSA and U.S. Department of Health and Human Services guidelines
  • Disciplines:
  • Infectious disease
  • References: • Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. 2015 Apr. 288 p.
    • Ahn JY, Boettiger D, Law M, Kumarasamy N, Yunihastuti E, Chaiwarith R, Lee MP, Sim BL, Oka S, Wong W, Kamarulzaman A, Kantipong P, Phanuphak P, Ng OT, Kiertiburanakul S, Zhang F, Pujari S, Ditangco R, Ratanasuwan W, Merati TP, Saphonn V, Sohn AH, Choi JY; TREAT Asia HIV Observational Databases (TAHOD). Implementation and operational research: effects of CD4 monitoring frequency on clinical endpoints in clinically stable HIV-infected patients with viral suppression. J Acquir Immune Defic Syndr. 2015 Jul 1;69(3):e85-92.

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