Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study.

Journal article

OBJECTIVES: To investigate delayed HIV diagnosis and late initiation of antiretroviral therapy (ART) in the Swiss HIV Cohort Study. METHODS: Two sub-populations were included: 1915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration (group A), and 1730 treatment-naïve patients with CD4>or=200 cells/microL before their second cohort visit (group B). In group A, predictors for low initial CD4 cell counts were examined with a median regression. In group B, we studied predictors for CD4<200 cells/microL without ART despite cohort follow-up. RESULTS: Median initial CD4 cell count in group A was 331 cells/microL; 31% and 10% were <200 and <50 cells/microL, respectively. Risk factors for low CD4 count were age and non-White race. Homosexual transmission, intravenous drug use and living alone were protective. In group B, 30% initiated ART with CD4>or=200 cells/microL; 18% and 2% dropped to CD4 <200 and <50 cells/microL without ART, respectively. Sub-Saharan origin was associated with lower probability of CD4 <200 cells/microL without ART during follow-up. Median CD4 count at ART initiation was 207 and 253 cells/microL in groups A and B, respectively. CONCLUSIONS: CD4<200 cells/microL and, particularly, CD4<50 cells/microL before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount.

Authors: Wolbers, M; Bucher, H; Furrer, H; Rickenbach, M; Cavassini, M

• Publication status: Published
• Journal: HIV medicine
• Volume: 9
• Issue: 6
• Pages: 397-405
• Publication date: 2008-07-01
• DOI: 10.1111/j.1468-1293.2008.00566.x
• EISSN: 1468-1293
• ISSN: 1464-2662
• Language: English
• Keywords: Adult; Early Diagnosis; Risk Factors; Male; Disease Progression; Drug Administration Schedule; AIDS-Related Opportunistic Infections; Female; Viral Load; Swiss HIV Cohort Study; CD4 Lymphocyte Count; HIV-1; HIV Infections; RNA, Viral; Humans; Anti-Retroviral Agents