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Supplementary antimicrobials for patients with HIV and <100 CD4 cells/µL are associated with improved survival
  1. George W Rutherford1,
  2. Elvin Geng2
  1. 1Department Global Health Sciences, University of California, San Francisco, California, USA
  2. 2Department of Medicine, University of California, San Francisco, California, USA
  1. Correspondence to Professor George W Rutherford, Department Global Health Sciences, University of California, San Francisco, CA 94143-1224, USA; George.Rutherford{at}

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Commentary on: Hakim J, Musiime V, Szubert AJ, et al. Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa. N Engl J Med 2017;377:233–45.


Despite expansion of HIV testing and recommendations to start antiretroviral therapy (ART) immediately, people living with HIV (PLWH) often present late in the disease. In poorer countries, 30%–40% of PLWH starting ART have CD4 counts <200 cells/µL and 20% have a CD4 count <100 cells/µL.1 PLWH with advanced immunosuppression are at greater risk for complications and death, and their care is more complex than those with early disease.

The WHO promotes differentiated service delivery2—a strategy that varies the intensity, frequency and location of treatment. To date, this has focused on deintensifying treatment for patients with higher CD4 counts. Hakim and colleagues offer a strategy for PLWH presenting with advanced disease.3 …

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