Have you checked your memory usage? Do you notice performance degrades as you play? What are your temps like?
GTA4 is a pig for stability. I've had no end of problems with the game not launching (RS logo and then a black screen), serious lag just on the menu screen, and CTDs...
I only recently worked out how to get a stable game - installed all XP updates, scan disk on my games drive, launch the Social Club and then launch the game via the desktop icon (never, ever, ever, ever use the SC Play button). Now I can play for hours without a hitch.