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To the Editor: In their study, Dr Rodriguez and colleagues¹ challenge the long-held view that baseline plasma HIV-1 RNA level is the best predictor of the rate of CD4 cell decline among untreated HIV-infected individuals, initially put forward by Mellors et al in 1997.² There are several methodological issues that may have contributed to this controversy.

Intraindividual variability of CD4 cell counts and plasma HIV-1 RNA levels is quite substantial.³ As a result, the signal-to-noise ratio associated with this measurement may have obscured an existing relationship over a relatively short follow-up time. Furthermore, the limits quantification of commercially available plasma HIV-1 RNA assays has evolved since 1996. For example, in British Columbia, plasma HIV-1 RNA measurements were obtained based on the Roche HIV-1 monitor standard assay from June 1996 to February 2000, and since March 2000 plasma HIV-1 RNA measurements have been based on the Roche COBAS HIV-1 monitor ultrasensitive . . . [Full Text of this Article]

Viviane D. Lima, PhD; Robert S. Hogg, PhD; Julio S. G. Montaner, MD
jmontaner@cfenet.ubc.ca
British Columbia Centre for Excellence in HIV/AIDS
St Paul's Hospital
University of British Columbia
Vancouver

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