The HIV Medicine Association issued recommendations for HIV tests and procedures that are frequently conducted, yet not always necessary, according to a press release.
The recommendations are part of the ABIM Foundation’s Choosing Wisely campaign, which aims to develop patient-friendly resource materials and encourages conversations between patients and medical providers about avoiding unnecessary care.
Carlos del Rio
“Providing high quality care to our patients also means not ordering unnecessary tests,” Carlos del Rio, MD, FIDSA, chair of HIVMA, said in the release. “Implementing these principles in our practice will save money by avoiding unnecessary tests.”
According to HIVMA:
- Physicians should avoid ordering CD4 tests for patients who are virally suppressed after 2 years of treatment initiation. Yearly CD4 measurements are recommended for patients with 300 cells/mm3 to 500 cells/mm3. Testing is optional for patients with CD4 counts above 500 cells/mm3.
- Physicians should not order complex lymphocyte panels when ordering CD4 counts.
- Quarterly viral load testing is not typically recommended for patients who have stable viral suppression. Testing should be conducted before treatment initiation, 2 to 8 weeks after initiation or modified therapy, then every 3 to 4 months until viral suppression is confirmed, the release said. After more than 2 years of viral suppression has passed, viral load testing may be conducted every 6 months.
- Routine glucose-6-phosphate dehydrogenase (G6PH) testing is not recommended for patients who are not inclined to G6PH deficiency. G6PH testing should only be conducted in HIV patients of African, Asian and/or Mediterranean descent when care is first initiated or when patients begin a regimen containing an oxidant drug.
- Physicians should not routinely test for cytomegalovirus (CMV) IgG in patients at a higher risk for CMV who can be assumed to be CMV-positive. Testing for latent CMV infection with an anti-CMV IgG is recommended in low-risk patients who also should be counseled on the importance of practicing safe sexual behaviors in order to avoid infection.