Effects of virologic rebound on CD4 cell counts [Bahrani A et al. CID 2001; 32: 1231]: The authors performed a retrospective cohort study of 497 patients with HIV infection to determine the effect of virologic rebound on CD4 cell counts after initial suppression to <400 c/ml. There were four groups based on the median HIV RNA level after virologic rebound. The study group included 134 patients, and the controls were 75 patients who maintained a viral load of <400 c/ml. The results are summarized in the table below, with mean increase in CD4 cell count at 24 months after virologic rebound to the designated levels.

CD4 Count Correlated with Viral Load Rebound
Viral Load Rebound	No.	CD4 Count Decrease
401 - 10,000	62	1.0 / mo
10,000 - 50,000	31	1.7 / mo
50,000 - 100,000	21	4.1 / mo
>100,000	20	6.6 / mo

These results show that the magnitude of virologic rebound is inversely correlated with the CD4 cell count.
Comment: This is an obvious result but one that is important to measure and emphasize at a time when there are many debates about the goals of therapy and the criteria for changing treatment.
posted 6/20/2001

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