Rapid declines in total lymphocyte count and hemoglobin in HIV infection begin at CD4 lymphocyte counts that justify antiretroviral therapy.

We investigated whether the onset of rapid declines in total lymphocyte counts and hemoglobin levels might be useful for staging HIV disease and initiating antiretroviral therapy. Using data from the Multicenter AIDS Cohort Study, we found that accelerated declines in both markers generally precede AIDS by 1.2 years and occur when the CD4 lymphocyte counts fall below 350 cells/mm. These markers may thus be suitable for monitoring disease and timing therapy initiation in resource-limited settings.