The authors of the article published in this issue of AIDS should be complimented on their study focusing on recent hospitalizations of HIV patients in South Africa . It is impressive that most of the patients had suppressed HIV RNA levels, and it is a tribute to the excellent care and effective antiretroviral therapy that these patients received. As a doctor who cared for the very first AIDS patients in Delaware beginning in 1981, it was reassuring that so few hospitalizations in this study were due to AIDS-defining illnesses, and that most cases of hospitalization due to AIDS-defining illnesses were associated with M. tuberculosis, not other opportunistic infections or malignancies.

The paper includes some interesting results that deserve to be highlighted. Of the 99 virally suppressed patients with HIV infection who were hospitalized, 27 patients had AIDS-defining conditions. The vast majority of these (22/27 or 82%) had active tuberculosis (TB). The median CD4+ lymphocyte count of the virally suppressed patients was almost 400, so these patients would not, by conventional laboratory criteria, be severely immunocompromised, especially since acute illness (including TB) is known to itself cause lymphopenia in HIV-uninfected patients . Only a small number of virally suppressed patients in this study had other AIDS-defining illnesses and included 2 cases of HIV-related non-Hodgkin's lymphoma, one case of disseminated Kaposi sarcoma, one case of recurrent cryptosporidium diarrhea, and a single case of disseminated Mycobacterium avium complex.

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