PONE-D-21-27285CD4+ cell count recovery after initiation of antiretroviral therapy in HIV-infected Ethiopian adultsPLOS ONE

Dear Dr. Fiseha,

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Additional Editor Comments:

Two additional very minor points for revision:

-Abstract: typo in RESULT of CD4 cell count >5000. It should be 500 instead.

-The outcome variable name for "poor CD4+ cell count recovery to >500 cells/mm3" was a bit difficult to understand without looking at the details. Did you mean poor recovery to reach the level above 500?

Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: This work documents the degree to which CD4 recovery occurs in an reasonably large Ethiopian cohort during the first 12 months of HIV therapy. The findings are consistent with those from other cohorts and reveals particularly for those patients starting therapy at low CD4 counts recovery is suboptimal. This is not uncommon at older ages, and in males but can occur for a large percentage of the population. While this is consistent across the world, there is not as much data from Africa, where the data is most relevant.

Since they appear to have the possibility of long-term follow-up what would substantially raise the value of this work would be some effort to document whether or not there were clinical consequences of either a <100 cell rise in CD4 counts, and/ or CD4 counts staying below 500 or some other lower thresholds. One Ugandan study they cited (Nakanjako et. Al. 2008) found no clinical difference between suboptimal and “more optimal” CD4 recovery, but the length of follow up was not as long as this cohort has. Any clinical data including mortality, hospitalization, tuberculosis acquisition/diagnosis would strengthen the emerging data that something in addition to antiviral therapy is needed in patients with suboptimal therapy.

Please also respond to comment in attached manuscript.

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Reviewer #1: No

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Attachments

Attachment

Submitted filename: PLOSoneCD4 recovery_reviewer1.pdf

CD4+ cell count recovery after initiation of antiretroviral therapy in HIV-infected Ethiopian adults

PONE-D-21-27285R1

Dear Dr. Fiseha,

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Kind regards,

Ngai Sze Wong

Academic Editor

PLOS ONE