HIV Medicine Association

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Released February 8, 2016

Avoid unnecessary CD4 tests.

A CD4 count is not required in conjunction with every viral load test. Viral load testing is a better indicator of a patient’s response to therapy. CD4 monitoring is not necessary for patients who have stable viral suppression. For the first two years after treatment initiation, the CD4 count should be monitored every three to six months. After two years, if the viral load is undetectable, the CD4 count should be measured yearly if it is 300–500 cells/mm3. If it is consistently above >500 cells/mm3 then further monitoring is optional.

1 These recommendations do not supersede grant reporting requirements.

2 Note: Some patients may still require a face to face visit every three to four months to make certain that other comorbid conditions are stable, and to assess if there are other social changes that might have surfaced which could impact HIV medication adherence. Multidisciplinary practices can consider interim visits with other non-prescribing practitioner team members to support treatment adherence.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

An expert work group composed of four members of HIVMA’s Board of Directors directed the development of HIVMA’s Choosing Wisely list of “Five Things Physicians and Patients Should Question.” The work group was provided with the ABIM Foundation guidelines on recommendation development, and identified a preliminary list of inappropriate and overused clinical practices. A list of five items was drafted and then vetted by the full HIVMA Board of Directors to develop a finalized list of consensus recommendations.

HIVMA’s disclosure and conflict of interest policy can be found at


Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at 2015 Apr. 288 p.

Ahn JY, Boettiger D, Law M, Kumarasamy N, Yunihastuti E, Chaiwarith R, Lee MP, Sim BL, Oka S, Wong W, Kamarulzaman A, Kantipong P, Phanuphak P, Ng OT, Kiertiburanakul S, Zhang F, Pujari S, Ditangco R, Ratanasuwan W, Merati TP, Saphonn V, Sohn AH, Choi JY; TREAT Asia HIV Observational Databases (TAHOD). Implementation and operational research: effects of CD4 monitoring frequency on clinical endpoints in clinically stable HIV-infected patients with viral suppression. J Acquir Immune Defic Syndr. 2015 Jul 1;69(3):e85-92.