Proposition about the end of CD4 tests in Brazil raises debate

Publicação: 11 de August de 2014

The theme is also discussed among the international scientific community

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Experts say the test is a right of HIV positive people. NGOs and entities such as the National Network of People living with HIV/Aids should be heard

The possible end of new acquisitions of the CD4 exam by the Health Ministry (HM) in 2015, according to an article by Agencia Estado  has raised discussions especially among entities dealing directly with HIV positive people. The procedure is considered to be fundamental for patients to know their immune and viral conditions and decide about the treatment.

The current HM protocols recommend immediate start of antiretroviral therapy (ART) regardless of the result of the CD-4 T-cells count, that evaluates the virus’ progress – when below 200 per microliter, the official AIDS diagnostic is confirmed.  The non-operation of the procedure immediately after the clinical inspection, however, could interfere negatively in the adherence to the treatment and self care of people living with AIDS, according to Dr. Eliane Seidl,  PhD in psychology from Brasilia University (UnB).

“Even with the protocol, who effectively decides about starting the ART treatment or not is the patient. The doctor can prescribe the drugs, but if there is no confidence in the professional, maybe there will be no adherence to the treatment. The psychologist, who works with HIV positive people for 18 years though the Projeto Com-Vivencia, adds that eventual side effects are among the disadvantages of the early ART treatment, because the patient will be exposed to the drugs for a longer period in life. “I believe taking these tests is a right of the infected person. The NGOs and entities as National Network of People Living with HIV/AIDS (RNP+) should be heard abouth this theme”.

A factor that prevents the exam to be extinguished in the Country is that diagnostic in Brazil is still too late, according to Dr. Juan Carlos Raxach, project advisor of the Brazilian AIDS Interdisciplinary Association (ABIA). “Many people only discover their infections in a very advanced stage. This way, they need the CD4 test to know whether it is necessary of not to engage in prophylaxis (artifice to prevent the installation or propagation of diseases) against opportunist diseases. There is no other method that allows us to have this criteria and I believe there will not be an alternative in  a short-term”, affirms.

The Health Ministry was consulted for a month to deal about the theme, but until the closure of this article there was no response. Official data from the Office show that the federal government has 90 registered laboratories to conduct the CD4 tests and other 79 for viral load diagnosis.

The end of CD4 is far from being a consensus

The matter has been discussed among the international scientific community. In an article published by the Oxford University Press , the director of the HIV Progran and the Brigham and Women’s Hospital Infectious Diseases Division, Dr. Paul E. Sax , affirms that the most important reason to not measure CD4 in a routine basis in a stable patient is that the results will not affect the treatment, once in these cases rarely the levels drop below the clinically significant levels.

A study  published last year also says the test would not be necessary in stable patients. To reach such conclusion, researchers analyzed the registry of all interns in a HIV treatment clinic in Washington (USA) between September 1998 and December 2011, in an attempt to identify patients with continuous long-term viral load suppression. When those with apparent causes for CD4 cells count changes – such as severe infection, chemotherapy or interferon treatment (protein involved in the immune response) – were excluded from the analysis, none were left with a drop below 200 cells per microliter after two years of continuous virologic control.…