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CD4 counts at entry to HIV care unchanged since '92
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CD4 cell counts of patients with HIV initially presenting for medical care in developed countries have not significantly increased in the past 20 years, researchers from the University of North Carolina and University of Alabama at Birmingham reported.
“Whether CD4 cell count or clinical indicators are used to determine the timing of presentation, the implications of ‘late presentation’ have been consistent,” the researchers wrote in Clinical Infectious Diseases. “At the individual level, persons who present to care later are at a higher risk for morbidity and mortality and may not benefit from ART to the same extent as persons who present earlier. At the population level, timely entry to care has the potential to reduce HIV incidence.”
The researchers conducted a systematic review of studies published from 2000 to November 2011 to examine the CD4 counts of patients presenting for HIV care for the first time. The analysis included 44 studies, and 29 of those studies were conducted in the United States or the United Kingdom. The mean or median CD4 cell counts were abstracted from the data presented in the studies.
The 44 studies included 169,007 patients. Among these, the unadjusted estimated change in CD4 counts was 1.5 cells/mcL per year. In 1992, the average was 307 cells/mcL compared with 336 cells/mcL in 2011. After adjustment for study inclusion criteria, data type and study location, the estimated change in CD4 cell count did not change.
“Future studies should define the timing of their endpoint precisely and present the observed distribution of CD4 cell count to enable enhanced detection of temporal trends in clinical status at care entry,” the researchers wrote. “New and innovative strategies to identify persons earlier in the course of their HIV infection and link them promptly with medical care are clearly necessary and desperately needed to fully realize the individual and public health benefits afforded by contemporary HIV treatment.”
Disclosure: The researchers report no relevant financial disclosures.
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