Is the Rate of CD4 Cell Decline Changing Over Time in Antiretroviral-Naïve Patients?

Dear Editor, CD4+ cell counts are used to determine risk for HIV disease progression, eligibility for antiretroviral therapy (ART), and immunologic response to ART. A recent Brazilian study suggested that CD4 cell counts are declining more rapidly among recently infected patients than in the pre-combination ART era.1 Rates of CD4 cell decline were compared in a well-characterized clinical cohort from the Hospital das Clinicas (HCFMUSP) in Sao Paulo, Brazil, in patients diagnosed in the pre-ART era (