The study was well compiled and reported. However, the authors acknowledged the following limitations:
(a)The impact of quality of life adjustments is not certain and for opportunistic disease the likely effect is to reduce cost-effectiveness.
(b) There are limitations in using CD4+ counts as an outcome measure as it represents an intermediate indication of potential disease.
(c) Data from each country were based on a small group of physicians and were therefore subjective.
(d)Indirect costs were not addressed.
The validity of these results is therefore predicated on a number of constraints and assumptions.