To the Editor: In their 2010 guidelines, the International AIDS Society–USA panel reinforced the recommendation to initiate combination antiretroviral treatment (cART) in individuals infected with human immunodeficiency virus (HIV) with rapid CD4 cell count decline of greater than 100/μL per year (level of evidence rating AIIa).1,2 In so doing, the panel ignored recent evidence from the large CASCADE collaboration of a lack of association between the pretreatment CD4 cell slope and the hazards of AIDS and death in ART-naive patients.3
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