More than one-third of people diagnosed with HIV at four major clinics in large US cities already had CD4 cell counts below 200 cells/mm3, and were thus at immediate risk of AIDS-related illness, according to research published this week in the Journal of Infectious Diseases.
The study also found that more than half of patients were already candidates for antiretroviral therapy under US treatment guidelines, which recommend treatment for anyone with a CD4 cell count below 350 cells/mm3.
The study looked at medical records from 2223 people diagnosed with HIV in Washington DC, Los Angeles, New Jersey and Baltimore in 1999. 59% of those diagnosed were black, 12% Latino and 29% white, corresponding closely to the proportions of newly diagnosed individuals from various ethnic groups across the United States. No ethnic or sex differences in CD4 cell count at the time of HIV diagnosis were detected.
The authors recommend that efforts to promote HIV testing should be stepped up, both to improve an individual’s chances of a good response to treatment and to reduce the risk of transmission within the community.
A recent audit of UK treatment centres found a similar proportion of patients had been diagnosed with HIV and begun treatment with CD4 cell counts below 200 cells/mm3.
Dybul M et al. Evaluation of initial CD4+ T cell counts in individuals with newly diagnosed human immunodeficiency virus infection, by sex and race, in urban settings. Journal of Infectious Diseases 185: 1818-21, 2002.