Late presentation for human immunodeficiency virus care in the United States and Canada

Keri Althoff, Stephen J Gange, Marina B. Klein, John T. Brooks, Robert S. Hogg, Ronald J. Bosch, Michael A. Horberg, Michael S. Saag, Mari M. Kitahata, Amy C. Justice, Kelly Gebo, Joseph J. Eron, Sean B. Rourke, M. John Gill, Benigno Rodriguez, Timothy R. Sterling, Liviana M. Calzavara, Steven G. Deeks, Jeffrey N. Martin, Anita R. RachlisSonia Napravnik, Lisa Paula Jacobson, Gregory D Kirk, Ann C. Collier, Constance A. Benson, Michael J. Silverberg, Margot Kushel, James J. Goedert, Rosemary G. McKaig, Stephen E. Van Rompaey, Jinbing Zhang, Richard D Moore

Research output: Contribution to journalArticle

Abstract

Background. Initiatives to improve early detection and access to human immunodeficiency virus (HIV) services have increased over time. We assessed the immune status of patients at initial presentation for HIV care from 1997 to 2007 in 13 US and Canadian clinical cohorts. Methods. We analyzed data from 44,491 HIV-infected patients enrolled in the North American-AIDS Cohort Collaboration on Research and Design. We identified first presentation for HIV care as the time of first CD4- T lymphocyte (CD4) count and excluded patients who prior to this date had HIV RNA measurements, evidence of antiretroviral exposure, or a history of AIDS-defining illness. Trends in mean CD4 count (measured as cells/mm3) and 95% confidence intervals were determined using linear regression adjusted for age, sex, race/ethnicity, HIV transmission risk, and cohort. Results. Median age at first presentation for HIV care increased over time (range, 40-43 years; P<.01), whereas the percentage of patients with injection drug use HIV transmission risk decreased (from 26% to 14%; P3 (interquartile range, 96-455 cells/mm3) to 317 cells/mm3 (interquartile range, 135517 cells/mm3) from 1997 to 2007 (P <.01). The percentage of patients with a CD4 count 3=350 cells/mm3 at first presentation also increased from 1997 to 2007 (from 38% to 46%; P3 per year (95% confidence interval, 5-7 cells/mm3 per year). Conclusion. CD4 count at first presentation for HIV care has increased annually over the past 11 years but has remained 3, which suggests the urgent need for earlier HIV diagnosis and treatment.

Original languageEnglish (US)
Pages (from-to)1512-1520
Number of pages9
JournalClinical Infectious Diseases
Volume50
Issue number11
DOIs
StatePublished - Jun 1 2010

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Canada
HIV
CD4 Lymphocyte Count
Acquired Immunodeficiency Syndrome
Confidence Intervals
Lymphocyte Count
Linear Models
Research Design
RNA
T-Lymphocytes
Injections
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Late presentation for human immunodeficiency virus care in the United States and Canada. / Althoff, Keri; Gange, Stephen J; Klein, Marina B.; Brooks, John T.; Hogg, Robert S.; Bosch, Ronald J.; Horberg, Michael A.; Saag, Michael S.; Kitahata, Mari M.; Justice, Amy C.; Gebo, Kelly; Eron, Joseph J.; Rourke, Sean B.; John Gill, M.; Rodriguez, Benigno; Sterling, Timothy R.; Calzavara, Liviana M.; Deeks, Steven G.; Martin, Jeffrey N.; Rachlis, Anita R.; Napravnik, Sonia; Jacobson, Lisa Paula; Kirk, Gregory D; Collier, Ann C.; Benson, Constance A.; Silverberg, Michael J.; Kushel, Margot; Goedert, James J.; McKaig, Rosemary G.; Van Rompaey, Stephen E.; Zhang, Jinbing; Moore, Richard D.

In: Clinical Infectious Diseases, Vol. 50, No. 11, 01.06.2010, p. 1512-1520.

Research output: Contribution to journalArticle

Althoff, K, Gange, SJ, Klein, MB, Brooks, JT, Hogg, RS, Bosch, RJ, Horberg, MA, Saag, MS, Kitahata, MM, Justice, AC, Gebo, K, Eron, JJ, Rourke, SB, John Gill, M, Rodriguez, B, Sterling, TR, Calzavara, LM, Deeks, SG, Martin, JN, Rachlis, AR, Napravnik, S, Jacobson, LP, Kirk, GD, Collier, AC, Benson, CA, Silverberg, MJ, Kushel, M, Goedert, JJ, McKaig, RG, Van Rompaey, SE, Zhang, J & Moore, RD 2010, 'Late presentation for human immunodeficiency virus care in the United States and Canada', Clinical Infectious Diseases, vol. 50, no. 11, pp. 1512-1520. https://doi.org/10.1086/652650
Althoff, Keri ; Gange, Stephen J ; Klein, Marina B. ; Brooks, John T. ; Hogg, Robert S. ; Bosch, Ronald J. ; Horberg, Michael A. ; Saag, Michael S. ; Kitahata, Mari M. ; Justice, Amy C. ; Gebo, Kelly ; Eron, Joseph J. ; Rourke, Sean B. ; John Gill, M. ; Rodriguez, Benigno ; Sterling, Timothy R. ; Calzavara, Liviana M. ; Deeks, Steven G. ; Martin, Jeffrey N. ; Rachlis, Anita R. ; Napravnik, Sonia ; Jacobson, Lisa Paula ; Kirk, Gregory D ; Collier, Ann C. ; Benson, Constance A. ; Silverberg, Michael J. ; Kushel, Margot ; Goedert, James J. ; McKaig, Rosemary G. ; Van Rompaey, Stephen E. ; Zhang, Jinbing ; Moore, Richard D. / Late presentation for human immunodeficiency virus care in the United States and Canada. In: Clinical Infectious Diseases. 2010 ; Vol. 50, No. 11. pp. 1512-1520.
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abstract = "Background. Initiatives to improve early detection and access to human immunodeficiency virus (HIV) services have increased over time. We assessed the immune status of patients at initial presentation for HIV care from 1997 to 2007 in 13 US and Canadian clinical cohorts. Methods. We analyzed data from 44,491 HIV-infected patients enrolled in the North American-AIDS Cohort Collaboration on Research and Design. We identified first presentation for HIV care as the time of first CD4- T lymphocyte (CD4) count and excluded patients who prior to this date had HIV RNA measurements, evidence of antiretroviral exposure, or a history of AIDS-defining illness. Trends in mean CD4 count (measured as cells/mm3) and 95{\%} confidence intervals were determined using linear regression adjusted for age, sex, race/ethnicity, HIV transmission risk, and cohort. Results. Median age at first presentation for HIV care increased over time (range, 40-43 years; P<.01), whereas the percentage of patients with injection drug use HIV transmission risk decreased (from 26{\%} to 14{\%}; P3 (interquartile range, 96-455 cells/mm3) to 317 cells/mm3 (interquartile range, 135517 cells/mm3) from 1997 to 2007 (P <.01). The percentage of patients with a CD4 count 3=350 cells/mm3 at first presentation also increased from 1997 to 2007 (from 38{\%} to 46{\%}; P3 per year (95{\%} confidence interval, 5-7 cells/mm3 per year). Conclusion. CD4 count at first presentation for HIV care has increased annually over the past 11 years but has remained 3, which suggests the urgent need for earlier HIV diagnosis and treatment.",
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TY - JOUR

T1 - Late presentation for human immunodeficiency virus care in the United States and Canada

AU - Althoff, Keri

AU - Gange, Stephen J

AU - Klein, Marina B.

AU - Brooks, John T.

AU - Hogg, Robert S.

AU - Bosch, Ronald J.

AU - Horberg, Michael A.

AU - Saag, Michael S.

AU - Kitahata, Mari M.

AU - Justice, Amy C.

AU - Gebo, Kelly

AU - Eron, Joseph J.

AU - Rourke, Sean B.

AU - John Gill, M.

AU - Rodriguez, Benigno

AU - Sterling, Timothy R.

AU - Calzavara, Liviana M.

AU - Deeks, Steven G.

AU - Martin, Jeffrey N.

AU - Rachlis, Anita R.

AU - Napravnik, Sonia

AU - Jacobson, Lisa Paula

AU - Kirk, Gregory D

AU - Collier, Ann C.

AU - Benson, Constance A.

AU - Silverberg, Michael J.

AU - Kushel, Margot

AU - Goedert, James J.

AU - McKaig, Rosemary G.

AU - Van Rompaey, Stephen E.

AU - Zhang, Jinbing

AU - Moore, Richard D

PY - 2010/6/1

Y1 - 2010/6/1

N2 - Background. Initiatives to improve early detection and access to human immunodeficiency virus (HIV) services have increased over time. We assessed the immune status of patients at initial presentation for HIV care from 1997 to 2007 in 13 US and Canadian clinical cohorts. Methods. We analyzed data from 44,491 HIV-infected patients enrolled in the North American-AIDS Cohort Collaboration on Research and Design. We identified first presentation for HIV care as the time of first CD4- T lymphocyte (CD4) count and excluded patients who prior to this date had HIV RNA measurements, evidence of antiretroviral exposure, or a history of AIDS-defining illness. Trends in mean CD4 count (measured as cells/mm3) and 95% confidence intervals were determined using linear regression adjusted for age, sex, race/ethnicity, HIV transmission risk, and cohort. Results. Median age at first presentation for HIV care increased over time (range, 40-43 years; P<.01), whereas the percentage of patients with injection drug use HIV transmission risk decreased (from 26% to 14%; P3 (interquartile range, 96-455 cells/mm3) to 317 cells/mm3 (interquartile range, 135517 cells/mm3) from 1997 to 2007 (P <.01). The percentage of patients with a CD4 count 3=350 cells/mm3 at first presentation also increased from 1997 to 2007 (from 38% to 46%; P3 per year (95% confidence interval, 5-7 cells/mm3 per year). Conclusion. CD4 count at first presentation for HIV care has increased annually over the past 11 years but has remained 3, which suggests the urgent need for earlier HIV diagnosis and treatment.

AB - Background. Initiatives to improve early detection and access to human immunodeficiency virus (HIV) services have increased over time. We assessed the immune status of patients at initial presentation for HIV care from 1997 to 2007 in 13 US and Canadian clinical cohorts. Methods. We analyzed data from 44,491 HIV-infected patients enrolled in the North American-AIDS Cohort Collaboration on Research and Design. We identified first presentation for HIV care as the time of first CD4- T lymphocyte (CD4) count and excluded patients who prior to this date had HIV RNA measurements, evidence of antiretroviral exposure, or a history of AIDS-defining illness. Trends in mean CD4 count (measured as cells/mm3) and 95% confidence intervals were determined using linear regression adjusted for age, sex, race/ethnicity, HIV transmission risk, and cohort. Results. Median age at first presentation for HIV care increased over time (range, 40-43 years; P<.01), whereas the percentage of patients with injection drug use HIV transmission risk decreased (from 26% to 14%; P3 (interquartile range, 96-455 cells/mm3) to 317 cells/mm3 (interquartile range, 135517 cells/mm3) from 1997 to 2007 (P <.01). The percentage of patients with a CD4 count 3=350 cells/mm3 at first presentation also increased from 1997 to 2007 (from 38% to 46%; P3 per year (95% confidence interval, 5-7 cells/mm3 per year). Conclusion. CD4 count at first presentation for HIV care has increased annually over the past 11 years but has remained 3, which suggests the urgent need for earlier HIV diagnosis and treatment.

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