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Presenting CD4-Cell Count Is Rising, but Slowly

Summary and Comment |
October 9, 2013

Presenting CD4-Cell Count Is Rising, but Slowly

  1. Kelly Gebo, MD, MPH

A mean annual increase of about 1.5 cells/mm3, according to a meta-analysis of 44 studies in high-income countries, represents very modest progress.

  1. Kelly Gebo, MD, MPH

HIV-infected patients classified as “late presenters” face, by definition, a delay in initiation of antiretroviral therapy (ART) and, at a population level, may increase overall HIV incidence and costs of care. Researchers have now analyzed data from nearly 170,000 HIV-infected patients in 44 studies in the U.S., Canada, and Europe, to identify trends in CD4-cell count presentation from 1992 through 2011 (the studies were published from 2000 through 2011).

The analysis showed an increase in mean CD4-cell count at presentation of about 1.5 cells/mm3 per year, from 307 cells/mm3 in 1992 to 336 cells/mm3 in 2011. The estimated changes in the percentage of patients who presented with advanced disease (CD4 count <200 cells/mm3) and in those who presented late (CD4 count <350 cells/mm3 or with AIDS) were both <0.1% per year.

Comment

Despite numerous improvements in HIV diagnosis, treatment, and efforts to increase access to care, we have not appreciably changed new presenters' stage of disease for almost 2 decades. A U.S. and Canadian study of HIV-infected patients who presented to care from 1997 through 2007 estimated the adjusted increase in median CD4-cell count at presentation at roughly 6 cells/mm3 (NEJM JW AIDS Clin Care May 10 2010), but even that result suggests we are making insufficient headway. Efforts must focus on the patients at highest risk for HIV infection, including young men who have sex with men, and timely initiation of ART for those who test positive. These efforts are essential in reducing HIV transmission rates.

Dr. Gebo is Associate Professor of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, and Associate Professor of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore. She reports no conflicts of interest.

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