@article{b2b2cd1efeab4c44a3e4f7de1d020164,
title = "CD4 count at presentation for HIV care in the United States and Canada: Are those over 50 years more likely to have a delayed presentation?",
abstract = "We assessed CD4 count at initial presentation for HIV care among ≥50-year-olds from 1997-2007 in 13 US and Canadian clinical cohorts and compared to <50-year-olds. 44,491 HIV-infected individuals in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) were included in our study. Trends in mean CD4 count (measured as cells/mm3) and 95% confidence intervals ([,]) were determined using linear regression stratified by age category and adjusted for gender, race/ethnicity, HIV transmission risk and cohort. From 1997-2007, the proportion of individuals presenting for HIV care who were ≥50-years-old increased from 17% to 27% (p-value < 0.01). The median CD4 count among ≥50 year-olds was consistently lower than younger adults. The interaction of age group and calendar year was significant (p-value <0.01) with both age groups experiencing modest annual improvements over time (< 50-year-olds: 5 [4 , 6] cells/mm3; ≥50-year-olds: 7 [5 , 9] cells/mm3), after adjusting for sex, race/ethnicity, HIV transmission risk group and cohort; however, increases in the two groups were similar after 2000. A greater proportion of older individuals had an AIDS-defining diagnosis at, or within three months prior to, first presentation for HIV care compared to younger individuals (13% vs. 10%, respectively). Due to the increasing proportion, consistently lower CD4 counts, and more advanced HIV disease in adults ≥50-year-old at first presentation for HIV care, renewed HIV testing efforts are needed.",
author = "Althoff, {Keri N.} and Gebo, {Kelly A.} and Gange, {Stephen J.} and Klein, {Marina B.} and Brooks, {John T.} and Hogg, {Robert S.} and Bosch, {Ronald J.} and Horberg, {Michael A.} and Saag, {Michael S.} and Kitahata, {Mari M.} and Eron, {Joseph J.} and Sonia Napravnik and Rourke, {Sean B.} and Gill, {M. John} and Benigno Rodriguez and Sterling, {Timothy R.} and Deeks, {Steven G.} and Martin, {Jeffrey N.} and Jacobson, {Lisa P.} and Kirk, {Gregory D.} and Collier, {Ann C.} and Benson, {Constance A.} and Silverberg, {Michael J.} and Goedert, {James J.} and McKaig, {Rosemary G.} and Jennifer Thorne and Anita Rachlis and Moore, {Richard D.} and Justice, {Amy C.}",
note = "Funding Information: We are grateful to all patients, physicians, investigators, and staff involved in the NA-ACCORD. This work was supported by grants from the National Institutes of Health: U01-AI069918, U01-AA013566, U01-AI31834, U01-AI34989, U01-AI34993, U01-AI34994, U01-AI35004, U01-AI35039, U01-AI35040, U01-AI35041, U01-AI35042, U01-AI35043, U01-AI37613, U01-AI37984, U01-AI38855, U01-AI38858, U01-AI42590, U01-AI68634, U01-AI68636, U01-HD32632, M01-RR00071, M01-RR00079, M01-RR00083, M01-RR00722, P30-AI27757, P30-AI27767, P30-AI50410, P30-AI54999, R01-DA04334, R01-DA12568, R01-MH54907, R24-AI067039, Z01-CP010176, AHQ290-01-0012, N02-CP55504, R01-DA11602, AI-69432, K01-AI071754, R01-AA16893, K24-00432, K23-AI-61-0320. This work was also supported by the Centers for Disease Control (CDC200-2006-18797), the Canadian Institutes for Health Research (CIHR: TGF-96118; HCP-97105; CBR-86906; CBR-94036; KRS-86251; 169621) and the Canadian Trials Network (project number 242). NA-ACCORD Participating cohorts (representatives): AIDS Link to the IntraVenous Experience (Gregory D.Kirk) Adult AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (Constance A. Benson, Ronald J. Bosch, Ann C. Collier) HAART Observational Medical Evaluation and Research (Robert S. Hogg, Richard Harrigan, Julio Montaner) HIV Outpatient Study (John T. Brooks, Kate Buchacz) HIV Research Network (Kelly A. Gebo) Johns Hopkins HIV Clinical Cohort (Richard D. Moore) John T. Carey Special Immunology Unit Patient Care and Research Database, Case Western Reserve University (Benigno Rodriguez) Kaiser Permanente Northern California (Michael A. Horberg, Michael J. Silverberg) Longitudinal Study of Ocular complications of AIDS (Jennifer E. Thorne) Multicenter Hemophilia Cohort Study-II (James J. Goedert) Multicenter AIDS Cohort Study (Lisa P. Jacobson) Montreal Chest Institute Immunodeficiency Service Cohort (Marina B. Klein) Ontario HIV Treatment Network Cohort Study (Sean B. Rourke, Anita R. Rachlis) Southern Alberta Clinic Cohort (M. John Gill) Studies of the Consequences of the Protease Inhibitor Era (Steven G, Deeks, Jeffery N. Martin) University of Alabama at Birmingham 1917 Clinic Cohort (Michael S. Saag, Michael Mugavero, James Willig) University of North Carolina, Chapel Hill HIV Clinic Cohort (Joseph J. Eron, Sonia Napravnik) University of Washington HIV Cohort (Mari M. Kitahata and Heidi M. Crane) Veterans Aging Cohort Study (Amy C. Justice, David Fiellin) Vanderbilt-Meharry CFAR Cohort (Timothy R. Sterling, Sam Stinette, Peter Rebeiro, David Haas) Women{\textquoteright}s Interagency HIV Study (Stephen J. Gange, Kathryn Anastos) Executive Committee: Richard D. Moore, Michael S. Saag, Stephen J. Gange, Mari M. Kitahata, Rosemary G. McKaig, Aimee Freeman Epidemiology/Biostatistics Core: Stephen J. Gange, Alison G. Abraham, Bryan Lau, Keri N. Althoff, Jinbing Zhang Data Management Core: Mari M. Kitahata, Stephen E. Van Rompaey, Heidi M. Crane, Eric Webster, Liz Morton, Brenda Simon 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. 2Department of",
year = "2010",
month = dec,
day = "15",
doi = "10.1186/1742-6405-7-45",
language = "English (US)",
volume = "7",
journal = "AIDS research and therapy",
issn = "1742-6405",
publisher = "BioMed Central",
}