Trends in immunologic and clinical status of newly diagnosed HIV-positive patients initiating care in the HAART era.
OBJECTIVE
To evaluate whether the availability of highly active antiretroviral therapy (HAART) has motivated people at risk for HIV infection to be tested earlier.


METHODS
Data are from the Adult and Adolescent Spectrum of HIV Disease (ASD) Study, a chart review study of HIV-infected people receiving care. The sample comprised newly diagnosed HIV-positive persons initiating care at five ASD clinics in New York City (NYC) 1994 to 1999. CD4 + lymphocyte count and clinical status (asymptomatic, major AIDS-related symptoms, AIDS-defining opportunistic illnesses) at first visit were ascertained. Trends in these two outcomes were analyzed comparing each time period after the second half of 1996 with the aggregate period from 1994 to the first half of 1996.


RESULTS
Between 1994 and 1999, we identified 545 patients newly diagnosed as positive for HIV with a first visit to an ASD clinic. Patients were predominantly black or Hispanic (93%). The mean CD4 + count at baseline was 246 cells/microl and the median was 152 cells/microl. After adjusting for covariates, the mean CD4 + count of newly diagnosed HIV-positive patients was significantly lower ( p =.04) only during the second half of 1997. The proportion of patients who were asymptomatic at baseline ranged from 29% in the second half of 1998 to 61% in the first half of 1994 (chi 2 = 48.8; p =.0008). After adjustment for covariates, the probability of a patient having a major symptom or an opportunistic illness at baseline was significantly higher only during the second half of 1998 ( p =.001).


CONCLUSIONS
During most time periods, both before and after the introduction of HAART, most newly diagnosed patients at these five HIV clinics in NYC were immune suppressed and symptomatic.
Sackoff
J E
JE
New York City Department of Health, HIV/Surveillance Program, New York, New York 10013, USA. jes20@Columbia.edu
Shin
S S
SS
D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count / Q000639:trends*; D003695:Delivery of Health Care; D015658:HIV Infections / Q000188:drug therapy / Q000208:ethnology / Q000276:immunology*; D006801:Humans; D008137:Longitudinal Studies; D009519:New York City / Q000453:epidemiology