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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?

Creators: Althoff, Keri N, Gebo, Kelly A, Gange, Stephen J, Klein, Marina B, Brooks, John T, Hogg, Robert S, Bosch, Ronald J, Horberg, Michael A, Saag, Michael S, Kitahata, Mari M, Eron, Joseph J, Napravnik, Sonia, Rourke, Sean B, Gill, M John, Rodriguez, Benigno, Sterling, Timothy R, Deeks, Steven G, Martin, Jeffrey N, Jacobson, Lisa P, Kirk, Gregory D, Collier, Ann C, Benson, Constance A, Silverberg, Michael J, Goedert, James J, McKaig, Rosemary G, Thorne, Jennifer, Rachlis, Anita, Moore, Richard D, Justice, Amy C,

File Type: pdf | Filesize: 253.4 KB | Date Added: 2012-08-23 | Date Created: 2010-12-15

Abstract We assessed CD4 count at initial presentation for HIV care among &#8805;50-year-olds from 1997-2007 in 13 US and Canadian clinical cohorts and compared to &lt;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 &#8805;50-years-old increased from 17% to 27% (p-value &lt; 0.01). The median CD4 count among &#8805;50 year-olds was consistently lower than younger adults. The interaction of age group and calendar year was significant (p-value &lt;0.01) with both age groups experiencing modest annual improvements over time (&lt; 50-year-olds: 5 [4 , 6] cells/mm3; &#8805;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 &#8805;50-year-old at first presentation for HIV care, renewed HIV testing efforts are needed.