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June 8, 1994

Depression and CD4 Decline-Reply

Author Affiliations

New York Hospital—Cornell Medical Center New York, NY

JAMA. 1994;271(22):1744. doi:10.1001/jama.1994.03510460035025

In Reply.  —We appreciate the letter by Dr Barrett and colleagues because it provides another opportunity to acknowledge their study's potential theoretical contribution as well as to emphasize why the clinical significance of their results must be interpreted with caution.In our Editorial, we primarily addressed what physicians and their HIV-infected patients should believe when presented with contradictory findings regarding the effect of depressive symptoms on CD4 decline. Because Lyketsos et al1 failed to find even a small effect despite immense statistical power and because no effect had been found by previous large studies,2-4 we concluded that the small effect found by Burack et al5 may have been attributable to peculiarities in their subjects or to methodological problems (such as a smaller sample more prone to the distortions of outliers or a lower limit of CD4 assessments with less-reliable estimates of CD4 decline).As a shorthand way

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