Should Clinicians Order a “Naive CD4-Cell Count” Before Initiating ART?

A substantial proportion of HIV-infected patients on antiretroviral therapy (ART) never achieve peripheral CD4-cell restoration, despite many years of viral-load suppression. Is there a way to identify these patients upfront, so that they can start ART earlier, before profound depletion of the peripheral CD4 cells?

Researchers retrospectively analyzed pooled data from five large treatment studies to determine whether the percentage of naive CD4 cells in peripheral blood before ART initiation might predict increases in CD4-cell counts after initiation. The analysis involved 348 antiretroviral-naive patients (median age, 36; 87% men) who were initiating ART at CD4 counts between 200 and 500 cells/mm³ (median, 321 cells/mm³).

During 2 years of f…