Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: The study by Dr Rodriguez and colleagues1 concludes that presenting human immunodeficiency virus (HIV) plasma RNA viral load only minimally predicts the rate of CD4 cell decline in individuals with HIV infection and hypothesizes that a significant (>90%) amount of HIV disease progression and pathogenesis is due to factors other than viral load. This is further discussed in the accompanying editorial by Drs Henry, Tebas, and Lane.2 The results are portrayed as casting doubt on the utility of an early viral load measurement to predict disease outcome in individuals. However, these results actually highlight the interindividual variability of the association between 2 surrogate markers. With further investigation, the results may indeed impugn the reliability of early CD4 T-cell loss trajectory estimates, but this study does not address either (1) the reliability of RNA viral load measurements for predicting the critical outcome of the development of clinical AIDS or death or (2) the utility of CD4 cell measurements for predicting AIDS.
Gottlieb GS, Hawes SE, Nickle DC, Herbeck JT, Kiviat NB, Mullins JI, Sow PS. Presenting Plasma HIV RNA Level and Rate of CD4 T-Cell Decline. JAMA. 2007;297(8):805-807. doi:10.1001/jama.297.8.805-a