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.’
Performance of a high-throughput next-generation sequencing method for analysis of HIV drug resistance and viral load
