Race and CD4+ T-cell count in HIV prognosis and treatment

CD4(+) T-cell count is known to vary by race in HIV-negative individuals. While people of certain races, such as blacks and Asians, continue to be disproportionately burdened by HIV/AIDS, they remain under-represented in most HIV clinical studies. Recent studies suggest that CD4(+) count evolution in HIV, before and after therapy, may differ by race. In this review, we summarize the evidence from prospective cohorts comparing CD4(+) count trajectories by race, and whether it is of any clinical significance. We find that although minor differences in CD4(+) count trajectories exist between people of diverse races, socioeconomic, cultural and environmental differences are far more important in predicting clinical outcomes than racial differences in CD4(+) count. Furthermore, current evidence does not support the need for any race or ethnicity-specific CD4(+) thresholds for ART and prophylactic therapy initiation. Future long-term trials in racially diverse populations are required to substantiate these findings.