Background: Earlier HIV diagnosis and engagement in care improve outcomes and is cost effective, as a result, in 2006, the Centers for Disease Control and Prevention (CDC) revised the HIV-screening guidelines. We sought to determine whether the CD4 count (CD4) at presentation, a surrogate for time to presentation, increased during the study period. Our a priori hypothesis was that the CD4 at presentation increased during the study period, particularly after the CDC guideline revision.
Methods: We performed a retrospective cohort study and analyzed data from the HIV Research Network, a consortium of 18 US clinics caring for HIV-infected patients. HIV-infected adults (≥18 years old) newly presenting for care between 2003 and 2011 were included in this study. Multivariable linear regression examined associations with CD4 at enrollment. Calendar year was modeled as a linear spline with a change in slope at 2008, allowing determination of the mean change in CD4 per year during 2003–2007 and 2008–2011.
Results: Over 13,543 newly presenting subjects enrolled from 2003 to 2011. Median CD4 at enrollment rose from 285 to 317 cells per cubic millimeter between 2003–2007 and 2008–2011 (P < 0.001). After adjusting for age, race/ethnicity, gender, HIV risk factor, and clinic site, the mean increase in the CD4 count at presentation per year was 13.3 cells per cubic millimeter per year (95% confidence interval 6.4 to 20.1 cells per cubic millimeter per year) greater during 2008–2011 than during 2003–2007.
Conclusions: We demonstrate a small, but statistically significant, increase in CD4 at presentation after the CDC guideline revision. More efforts are needed to decrease time to presentation to HIV care.
*Division of Infectious Diseases, Department of Medicine, The Johns Hopkins of Medicine, Baltimore, MD;
†Agency for Healthcare Research and Quality (AHRQ);
‡Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and
§Jonathan Lax Treatment Center, Philadelphia, PA.
Correspondence to: Charles F. Haines, MD, PhD, Division of Infectious Diseases, Department of Medicine, The Johns Hopkins of Medicine, 1830 E. Monument Street, Room 435, Baltimore, MD 21287 (e-mail: firstname.lastname@example.org).
Sponsoring Agencies: Agency for Healthcare Research and Quality, Rockville, MD (Fred Hellinger, PhD, John Fleishman, PhD, Irene Fraser, PhD); Health Resources and Services Administration, Rockville, MD (Robert Mills, PhD, Faye Malitz, MS). Data Coordinating Center: Johns Hopkins University (Richard Moore, MD, Jeanne Keruly, CRNP, Kelly Gebo, MD, Cindy Voss, MA, Nikki Balding, MS).
These data were presented in part as on oral abstract presentation at IDWeek 2012, the annual meeting of the Infectious Diseases Society of America, in San Diego, CA on October 12–17, 2012.
K.A.G. reported having served as a consultant, having served on a scientific advisory board, and having received research funding from Tibotec. L.P.B. reported receiving research funding from Janssen Pharmaceuticals. No other disclosures were reported. C.F.H., S.A.B., B.R.Y., R.D.M., and K.A.G. are supported by the National Institutes of Health (5KL2-RR025006, K23-AI084854, K23-MH097647-01A1, R01-DA11602, K24-DA00432, R01-AA16893, RO1 AG026250). Data collection and the HIVRN data coordinating center are supported by the Agency for Healthcare Research and Quality (HHSA290201100007C).
C.F.H. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: C.F.H., J.A.F., L.P.B., K.A.G. Acquisition of data: R.D.M., K.A.G. Analysis and interpretation of data: C.F.H., J.A.F., B.R.Y., S.A.B., K.A.G. Drafting of the manuscript: C.F.H. Critical revision of the manuscript for important intellectual content: C.F.H., J.A.F., B.R.Y., S.A.B., R.D.M., L.P.B., K.A.G. Statistical analysis: C.F.H., J.A.F. Obtained Funding: R.D.M., K.A.G. Administrative, technical, or material support: R.D.M., K.A.G. Study supervision: R.D.M., K.A.G.
The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Disclaimer: The views expressed in this paper are those of the authors. No official endorsement by the National Institutes of Health or the Agency for Healthcare Research and Quality is intended or should be inferred.
Received November 27, 2013
Accepted May 05, 2014