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Bernard Hirschel, MD; Marc Pechère, MD, MSc
Geneva, Switzerland

Arch Intern Med. 1995;155(19):2129.

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In reply

The points raised by Glesby and Hoover are well taken. It is indeed difficult to tease out the multiple factors that influence prognosis in patients with human immunodeficiency virus infection, and we have been appropriately cautious in our conclusions.

However, some of the statements made by Glesby and Hoover do not seem plausible to us. Concerning CD4 counts as a yardstickfor immunosuppression: Patients with CD4 counts and mycobacterial infections who are treated with antimycobacterial drugs have a survival that is comparable to those with similar CD4 counts but no mycobacteria.^1,2 This suggests (but does not prove) that once mycobacteria are suppressed by treatment, patients are not worse off (ie, not more "immunosuppressed") than those with comparable CD4 counts who did not develop mycobacterial infections. In addition, prospective trials of prevention of mycobacterial infection with rifabutin and clarithromycin show diminished mortality in the treatment groups compared with the . . . [Full Text PDF of this Article]

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