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Troubles in the Relationship

Paul A. Volberding, MD

JAMA. 1994;271(5):392-393.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Quantifying CD4⁺ cells has been useful in staging human immunodeficiency virus (HIV) disease and, therefore, in deciding when to recommend HIV treatment or prophylactic antibiotics. Much more controversial, however, has been using CD4⁺ cell counts as an acquired immunodeficiency syndrome (AIDS)—qualifying diagnosis, and CD4⁺ cell number has been disappointing as a surrogate marker of the clinical benefits of antiretroviral drugs.¹ Of particular concern is that CD4⁺ depletion is a rather distal effect of HIV infection and may be influenced by other cofactors. Indeed, most clinicians appreciate that various acute infections, including HIV itself, may cause a temporary decrease in peripheral CD4⁺ cell numbers. Less often are we concerned about factors that may cause CD4⁺ cell counts to be unexpectedly elevated. . . . [Full Text PDF of this Article]

Author Affiliations
From the University of California, San Francisco, and the Division of Oncology/ AIDS Services, San Francisco (Calif) General Hospital.

Footnotes
Reprint requests to the Division of Oncology/AIDS Services, San Francisco General Hospital, 995 Potrero Ave, Ward 84, San Francisco, CA 94110 (Dr Volberding).

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