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Utility of CD4 Cell Count and Viral Load Assay in Hospitalized Patients with Known HIV Infection: High Value Care Exercise

[ Vol. 20 , Issue. 4 ]

Author(s):

Amos Lal and George M. Abraham*   Pages 486 - 490 ( 5 )

Abstract:


Purpose: Healthcare spending as a percentage of Gross domestic product (GDP) is at all-time high and continues to rise in the United States. The Centers for Medicare and Medicaid Services estimate that 33% of resources spent on healthcare goes to waste. As part of a ‘high value care’ exercise, we studied if estimating CD4 cell counts and HIV viral load in hospitalized patients with a known diagnosis of HIV led to any meaningful change in HAART regimen and discharge diagnosis.

Methods: Retrospective chart review for all patients admitted with a known diagnosis of HIV from January 1, through December 31, 2017.

Results: A total of 83 patient encounters were reviewed during the period. The mean age was 54.1 ± 16.4 years, 64.1 % of patients were males. 75 patients (90.3%) were already on highly active antiretroviral therapy (HAART). The median hospital length of stay (LOS) was 3 days (IQR 2.0 - 5.0). The mean turnaround time for CD4 counts and HIV viral load assay was 2.9 days (95% CI 2.1 – 3.7) and 3.9 days (95% CI, 3.2 – 4.6), respectively. A CD4 count estimation led to no change in HAART regimen. HIV viral load assay testing had no impact on a change in treatment or a change in diagnosis.

Conclusions: In our study, testing CD4 counts and HIV viral load for inpatients did not confer any benefit in altering the diagnosis or HAART regimen. We believe that our study identifies a systems level opportunity to add to the concept of ‘Choosing Wisely.’

Keywords:

High value care, choosing wisely, HIV, CD4, Viral load, laboratory test, antibiotics.

Affiliation:

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, 200 1st St, SW, Rochester MN 55902, Department of Medicine, Saint Vincent Hospital, University of Massachusetts Medical School, Governor, MA Chapter, and Regent, American College of Physicians (ACP), 123 Summer Street, Worcester, MA 01608



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