Late Presentation for HIV Care in the United States and Canada
September 8, 2010
Noting that efforts to improve early detection and access to HIV services "have increased over time," the authors assessed patients' immune status at initial presentation for HIV care in 13 US and Canadian clinical cohorts from 1997 to 2007.
The data analyzed concerned 44,491 HIV-positive patients enrolled in the North American-AIDS Cohort Collaboration on Research and Design. Initial presentation for HIV care was identified as the time of the first CD4+ T lymphocyte (CD4) count. Patients who had HIV RNA measurements, evidence of exposure to antiretrovirals or a history of AIDS-defining illness prior to the first CD4 count were excluded from the analysis. Linear regression adjusted for age, sex, race/ethnicity, HIV transmission risk, and cohort was used to determine trends in mean CD4 count (measured as cells/mm3) and 95 percent confidence intervals (CI).
Over time, median age at initial presentation for HIV care increased (range 40-43 years; P<.01), while the proportion of patients at risk of HIV through injection drug use decreased (from 26 percent to 14 percent; P<.01) and heterosexual transmission risk increased (from 16 percent to 23 percent; P<.01). During the study period, median CD4 count at presentation increased from 256 cells/mm3 (interquartile range, 96-455 cells/mm3) to 317 cells/mm3 (interquartile range, 135-517 cells/mm3). The proportion of patients with a CD4 count of 350 or greater at first presentation rose from 38 percent to 46 percent (P<.01). The estimated adjusted mean CD4 count increased at a rate of 6 cells/mm3 per year (95 percent CI, 5-7 cells/mm3 per year).
"CD4 count at first presentation for HIV care has increased annually over the past 11 years but has remained <350 cells/mm3, which suggests the urgent need for earlier HIV diagnosis and treatment," the authors concluded.
Clinical Infectious Diseases
06.01.2010; Vol. 50: P. 1512-1520; Keri N. Althoff and others
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
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