Module 5: Management Of Employees With HIV/AIDS At Primary Level - Staging (Continued)

STAGING AND PROGNOSIS:

What do we know about the prognosis for each stage?

What does the CD4 cell count and viral load tell us?

Consider the "moving train" analogy:

• CD4 - tells us where patient is in terms of progression to AIDS.
• Viral load - tells us how fast patient is progressing to AIDS.

Cost of CD4 and viral load:

• CD4: (cell count) approximately R80.
• HIV RNA measurement or VL: R420.

So we (in Khayelitsha) only measure CD4 cell count at first visit and yearly thereafter if CD4 is between 300 and 500, and 6 monthly if closer to 200 per µl. A VL assay is only done before the initiation of ART in order to monitor ART. If it can be afforded, a VL assay will tell how fast patient progressing to AIDS.

The clinical stage: the CD4 cell count and HIV RNA level (viral load) estimation provide valuable prognostic information to:

• Decide what you need to tell the patient
• Decide when to start prophylaxis
• Decide when to start ART.