Time to reduce CD4+ monitoring for the management of antiretroviral therapy in HIV-infected individuals

Access to antiretroviral therapy (ART) is expanding at a rapid rate in resource-limited settings, with ambitious goals such as having 90% of infected individuals on ART by 2020. With the expansion of ART, there will be the need to expand assays for both HIV diagnosis and monitoring. To achieve these goals, clinical and diagnostic algorithms need to undergo constant review to ensure that they remain relevant and have the desired impact. While all assays used in HIV care need to be considered, this opinion focuses on the changes that could be made to CD4 + testing algorithms, resulting in reduced use allowing funds to be diverted to the current gold standard assay for measuring treatment success, the HIV viral load.