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In Reply: Dr Gottlieb and colleagues raise important and valid points regarding the study by Dr Rodriguez and colleagues¹ and our editorial. They correctly point out that the study focused exclusively on the relationship between plasma HIV-1 RNA levels and the decline in CD4 T-cell counts. They note that the lower viremia levels seen with HIV-2 infection appear to be directly related to the difference in pathogenicity between HIV-1 and HIV-2, and that when adjusted for plasma viral load, a similar rate of CD4 T-cell decline is seen in patients infected with HIV-1 and HIV-2.^2-3

Our editorial was not intended to imply that HIV-1 or HIV-2 replication is not central to HIV pathogenesis or risk for disease progression: they are. We did intend to raise the issue of the role of plasma HIV RNA levels in the assessment of an HIV-positive individual's rate of CD4 T-cell decline and spur interest . . . [Full Text of this Article]

W. Keith Henry, MD
keithh6680@aol.com
HIV Program
Hennepin County Medical Center
Minneapolis, Minn

Pablo Tebas, MD
University of Pennsylvania
Philadelphia

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