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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000228
Epidemiology and Prevention

Increase in CD4 Count Among New Enrollees in HIV Care in the Modern Antiretroviral Therapy Era

Haines, Charles F. MD, PhD*; Fleishman, John A. PhD; Yehia, Baligh R. MD, MPP, MSHP; Berry, Stephen A. MD, PhD*; Moore, Richard D. MD, MHS*; Bamford, Laura P. MD, MSCE‡,§; Gebo, Kelly A. MD, MPH*; for the HIV Research Network

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Abstract

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.

© 2014 by Lippincott Williams & Wilkins

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