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October 16, 1996

Controversies: Does the CD4+ Cell Count Reflect Clinical Efficacy?-Reply

Author Affiliations

University of California School of Medicine San Francisco

JAMA. 1996;276(15):1219-1220. doi:10.1001/jama.1996.03540150021018

In Reply.  —The response by Drs Kinloch-de-Loës and colleagues to my Controversies reiterates the difficulty in knowing whether surrogate markers give a true insight into a clinical benefit. I maintain my premise that drug therapy should mimic the natural cellular immune responses associated with low viral RNA to control HIV and sustain a longterm asymptomatic course. Kinloch-de-Loës et al emphasized neutralizing antibodies, but these most likely have no effect on a clinical course: the cellular immune response is the major component in preventing progression to disease. My emphasis has been on approaches to increase this cellular immune activity, which can control HIV by a variety of mechanisms, particularly suppression of virus replication.1 This comment, however, does not negate the conclusion by Kinloch-de-Loës et al (with which I agree) that a treatment regimen needs to be judged by its clinical effectiveness, not by any particular measure, although the reason for the effectiveness