Evaluation of Initial CD4⁺T Cell Counts in Individuals with Newly Diagnosed Human Immunodeficiency Virus Infection, by Sex and Race, in Urban Settings

Abstract

The CD4+ T cell count is an important determinant of disease stage and prognosis in human immunodeficiency virus (HIV)-infected individuals. This study evaluated the CD4+ T cell counts in individuals at the time of diagnosis of HIV infection at 4 community clinics in large urban settings with relatively high frequencies of HIV infection. Of 2223 individuals, 57% and 36% had CD4+ T cell counts < 350 and < 200 cells/mm(3), respectively, at the time of diagnosis. There were no clear differences by sex or race. Enhanced educational efforts regarding the importance of HIV testing for at-risk individuals across sex and race strata in community settings may be important for early identification of individuals with HIV infection. This in turn could impact efforts to reduce transmission, and it could impact the prognosis for patients who receive antiretroviral therapy.

Delay in Introducing Antiretroviral Therapy in Patients Infected by Hiv in Brazil, 2003-2006

“…12,13,14 Several studies have addressed the problems associated to 15 and the need for an early diagnosis of HIV infection. The proportion of patients with delayed initiation of ARVT varies widely according to region, but is generally significant 16 + T cell counts is available at the national level through SISCEL, forming the basis of the present analysis. The system is representative of the exams conducted by the public health system in the five regions because the CD4 + T cell count is considered a high complexity exam which must be registered in order for the laboratory to be reimbursed by the Brazilian health system.…”

Delayed access to HIV diagnosis and care: Special concerns for the Southern United States

“…Recent FDA approval of rapid HIV testing strategies with samehour results (CDC, 2003a) will likely increase the proportion of HIV-positive persons diagnosed early and who receive their results (Sy et al, 1998). However, the present circumstance with 30-40% of persons newly diagnosed receiving a concurrent AIDS diagnosis (Castilla et al, 2002;Dybul et al, 2002;Klein et al, 2003) severely limits the potential benefits of HIV medical care (Hogg et al, 2001;Palella et al, 2003;Phillips et al, 2001). At the University of Alabama at Birmingham (UAB) Outpatient Clinic for HIV/AIDS, referred to as the UAB 1917 Clinic, 53.6% of patients who presented with CDC-defined AIDS (n=498) between January, 1996 and December, 2004 were diagnosed with HIV in the year preceding their entry to care (Krawczyk et al, 2006).…”

Início da terapia anti-retroviral em estágio avançado de imunodeficiência entre indivíduos portadores de HIV/AIDS em Belo Horizonte, Minas Gerais, Brasil

“…Estudos brasileiros mostraram uma contagem média de linfócitos T CD4+ de 211 a 276 células/mm 3 entre pacientes em iní-cio de acompanhamento 16,17 , ou início imediato da TARV para importante parcela dos pacientes (41%) 18 . Além disso, outros autores indicam que a proporção de pacientes com imunodepressão avançada (< 200 células/mm 3 ) pode ser alta já na primeira consulta médica, variando de 36% a 50% 19,20,21 .…”

“…Tais fatores estão relacionados ao diagnós-tico tardio da infecção pelo HIV (e.g., desconhecimento do paciente quanto ao risco de infecção pelo HIV 19,22 e dificuldade de acesso à realização do anti-HIV 20 ); ao início tardio do acompanhamento nos serviços de saúde 23,24,25 , sendo o diagnóstico tardio o principal motivo; ao uso inadequado de serviço de saúde (e.g., acompanhamento clínico irregular 13 e atraso no monitoramento laboratorial 16 ) e ao próprio indivíduo (e.g., medo de reações adversas, esquemas posológicos complexos, sentir-se bem sem uso de ARV e uso de drogas ilícitas 12,26 ).…”