Role of the CD4 count in HIV management

As a result of successful antiretroviral treatment over the last 20 years, HIV has become more of a chronic disease for practitioners to manage, requiring careful, but routine, clinical monitoring. Laboratory markers, such as the HIV-1 RNA viral load and CD4 cell count, are regularly used for patient management in addition to predicting disease progression and/or treatment outcomes. The HIV viral load is considered to be the gold standard for evaluating treatment success, although it is often limited by the cost. Furthermore, in certain cases, there is a mismatch between an undetectable viral load (<50 copies/ml) and the absence of immune reconstitution, which can be confusing to both the treatment provider and patient. In this review, the utility of the CD4 count as a predictor for HIV disease progression in patients not on therapy is evaluated, as well as a method for monitoring a patient’s response to therapy. Its use in predicting immune reconstitution in patients initiating antiretrovirals is also id...