Dear Editor,
We read with interest the article titled “Rate of decline in CD4 counts in HIV patients not on antiretroviral therapy” by Patrikar et al published in Med J Armed Forces India 2014; 70: 134–138.1 In the introduction, authors have mentioned that they have attempted to determine the decline in CD4 count in HIV individuals and assessed the effects of time, treatment, initial CD4 count and age on the rate of CD4 cell count decline, but have excluded 24 patients who were already on antiretroviral therapy (ART). It is not clear as to effects of which treatment the authors are referring to. Similarly the effect of age on CD4 cell decline has not been mentioned in the results.
Variability in the rate of decline of CD4 count among individuals has been well discussed by the authors, but it is a well established fact that RNA viral load is a better predictor of rate of loss of CD4 cells at a population level.2 The high cost and non availability are the limiting factors and till the time this becomes freely available, only CD4 cell count will continue to decide the management strategies.
We are about to move into an era, where ART would be initiated even at very high CD4 cell counts as it yields better survival benefits.3
References
- 1.Patrikar S., Basannar D.R., Bhatti V.K. Rate of decline in CD4 counts in HIV patients not on antiretroviral therapy. Med J Armed Forces India. 2014;70:134–138. doi: 10.1016/j.mjafi.2013.08.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Williams BG, Korenromp EL, Gouws E, Dye C. The Rate of Decline of CD4 T-cells in People Infected with HIV. http://arxiv.org/abs/0908.1556.
- 3.Williams B.G. The benefits of early treatment for HIV. Correspondence. AIDS. 2010;24:1787–1797. doi: 10.1097/QAD.0b013e32833ac860. [DOI] [PubMed] [Google Scholar]