The majority of people diagnosed with HIV infection in England and Wales probably meet the criteria for starting HIV treatment the day that they test positive, according to new research by the Communicable Disease Surveillance Centre.
An analysis of the median CD4 count taken at the initial consultation after an HIV diagnosis shows that in 1998, half of those who tested positive that year had a CD4 count below 285, compared with a median of 290 in 1997 and 300 in 1996. In fact, there has been no significant change in the median CD4 count at diagnosis since recording began in 1990, according to a study published this week in AIDS.
When the researchers looked at the proportion of people identified with CD4 counts below 350, the difference was even more striking. Fifty-nine per cent of people who tested HIV-positive in 1998 were already below the threshold at which treatment is recommended when their infection was identified.
The British HIV Association recommends that anti-HIV treatment should start once the CD4 count has fallen below 350, if the patient is ready for the commitment of treatment.
Thirty-three per cent of people who tested positive in 1998 already had CD4 counts below 200, the level at which immediate prophylaxis against pneumocystis carinii pneumonia is recommended. The researchers found that men and women exposed to HIV through heterosexual intercourse (mainly of African origin) were likely to be diagnosed at much lower CD4 counts. The median initial CD4 count in this group was 230, approximately 100 cells lower than for gay men.
Reference
Gupta SW et al. CD4 cell counts in adults with newly diagnosed HIV infection: results of surveillance in England and Wales, 1990-1998. AIDS 14: 853-861, 2000.