Monitoring HIV Treatment in Resource‐Limited Settings: Reassuring News on the Usefulness of CD4+Cell Counts

The article by Brown et al. [1] in the current issue of the Journal is a careful assessment of the relative usefulness of virologic and immunologic markers, as well as other markers gathered in the third trimester of pregnancy, in predicting mortality among HIV-infected women in Nairobi, Kenya, during 1–2 years of follow-up after delivery. The findings indicated that the absolute CD4 cell count, as well as the CD4 cell percentage (CD4%), were the best predictors of mortality and that the measurement of maternal viral load did not improve prediction of maternal death With the rapid expansion of antiretroviral therapy (ART) in resource-limited settings, such as East Africa, one of the key clinical challenges has been to find cost-effective methods that are deliverable at the point of care to monitor patients’ responses to treatment and HIV disease progression. The study by Brown et al. [1] contributes to our knowledge by addressing the relative value of the CD4%, absolute CD4 cell count, and viral load, as well as other possible markers, including total lymphocyte count (TLC), hemoglobin, and body mass index (BMI), in predicting death at 1 and 2 years after delivery among HIV-1–infected women. The data were collected from a prospective cohort of HIV-1–infected pregnant women who were followed at a teaching hospital in Nairobi during 2 distinct periods: 216 women were monitored for 1 year after delivery between 1999 and 2002 and 319 women were monitored for up to 2 years after delivery between 2002 and 2005 (at a time when ART became much more widely available because of international donor funds). These combined data represented 10,150 person-months of follow-up, providing robustness and strength to the analyses and allowing a look not only at the predictive value of individual markers but also at combining multiple markers