title: Impact of laboratory-initiated reporting of CD4+ T lymphocytes on U.S. AIDS surveillance.
abstract: This study was conducted to measure the impact of laboratory-initiated reporting of CD4+ results on reporting of AIDS in the United States. States were categorized by whether CD4+ reporting was required; we compared the number and percentage of AIDS cases reported based on immunologic criteria, controlling for whether states also required HIV infection reporting. We observed cases reported in 1994 with CD4+ values and the delay between diagnosis and report by CD4+ and HIV-reporting status. From 1992 to 1994, states with CD4+ reporting had a greater proportionate increase in reported AIDS cases (98%) than states without CD4+ reporting (55%; p < 0.0001). From 1993 to 1994, the eight states with both CD4+ and HIV reporting had a higher increase in cases meeting immunologic criteria (7%) than the 13 states with only HIV reporting (< 1%), the three states with only CD4+ reporting (< 1%), and the 16 states with neither form of laboratory reporting (4%). Of 1987 definition cases reported in 1994, the percentage reported with CD4+ values was lower in states without either CD4+ or HIV reporting (79%) than in states with both CD4+ and HIV reporting (83%), only HIV reporting (84%), or only CD4+ reporting (88%). The percentage of AIDS cases reported within 3 months of diagnosis was lower in states without laboratory reporting (40%) than in states with CD4+ reporting (45%, p = 0.001). CD4+ reporting may enable states to report AIDS cases earlier in the course of HIV disease, permitting early targeting of health care and social services.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Klevens
authors.forename: P L
authors.initials: PL
authors.lastname: Fleming
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: J
authors.initials: J
authors.lastname: Karon
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000276:immunology; D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D018563:Disease Notification / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007753:Laboratories / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D014481:United States / Q000453:epidemiology