Background: Earlier HIV diagnosis and engagement in care improves 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 analyzing data from the HIV Research Network (HIVRN), 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 over the years 2003-07 and 2008-11.
Results: Over 13543 newly presenting subjects enrolled from 2003-11. Median CD4 at enrollment rose from 285 to 317 cells/mm3 between 2003-07 and 2008-11 (p<0.001). After adjusting for age, race/ethnicity, gender, HIV risk factor, and clinic site, the mean increase in CD4 count at presentation per year was 13.3 cells/mm3/year (95% Confidence Interval 6.4-20.1 cells/mm3/year) greater over the years 2008-11 than 2003-07.
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.
(C) 2014 by Lippincott Williams & Wilkins