Comment
The low median nadir CD4 count for the entire cohort (170 cells/mm3), together with the failure of many patients to achieve CD4 counts >500 cells/mm3 after years of suppressive ART, underscores the need for expansion of HIV testing and outreach efforts. The aim of those efforts would be to identify recently infected individuals, engage them in care, and initiate potent ART at higher CD4-cell counts, thus optimizing immune recovery and clinical benefit, with decreased transmission of HIV as a likely public health bonus. Although the potential benefits of early treatment seem clear, actual experience and the current economic outlook indicate that expanding provision of care to include most individuals with new HIV diagnoses will be difficult.
AIDS Clinical Care © 2011 Massachusetts Medical Society
