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To the Editor— We read with interest the article by Tierney et al. [1] concerning the prognostic value of baseline human immunodeficiency virus (HIV) DNA level measurements for determining disease progression in patients receiving antiretroviral therapy. Although a number of studies have clearly demonstrated that HIV DNA-infected cells in peripheral blood are important reservoirs of the virus and are maintained during successful treatment [2–5], no data are available on the role of this reservoir as a marker of progression in the absence of highly active antiretroviral therapy. As also suggested recently by others [6], Tierney et al. demonstrated that the HIV DNA level in peripheral blood mononuclear cells (PBMCs) is strongly associated with disease progression and survival, even if the HIV DNA level does not have a strong association with the CD4+ cell count. However, as Tierney et al. reported, the relatively narrow range of the CD4+ cell count used in their study made it difficult to observe any true association between CD4+ T cell counts and HIV DNA levels

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Correspondence
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