title: Late presenters in the era of highly active antiretroviral therapy: uptake of and responses to antiretroviral therapy.
abstract: OBJECTIVE
  To investigate the characteristics and clinical, immunological and virological outcomes for individuals presenting for care with low CD4 cell counts.
  
  
  METHODS
  Individuals aged > 16 years presenting for care for the first time were identified between 1 January 1996 and 31 December 2002. Late presenters were those with CD4 cell count < 50 x 10(6) cells/l. Follow-up was until last contact, death or 31 December 2002.
  
  
  RESULTS
  Late presenters formed 15.3% (110) of the group; they were more likely to be female (35% versus 24%), heterosexual (53% versus 38%), and of Black-African ethnicity (39% versus 27%) than other individuals. Over a median follow-up of 2.5 years, 13% of late presenters died. Ninety-nine patients started antiretroviral treatment; Of the 11 patients who did not start antiretroviral treatment, eight died within 3 months of presentation. Among those starting treatment, 87 (87.9%) achieved a viral load < 400 copies/ml and median CD4 cell counts increased from 43 x 10(6) cells/l at 0-2 months after presentation to 204 x 10(6) cells/l at 1 year. Over the first year, 71 patients attended at least one outpatient visit (median, 4.5; range, 0-39), 21 attended at least one day case visit (median, 0; range, 0-15) and 49 were admitted as an inpatient (median, 0; range, 0-4).
  
  
  CONCLUSIONS
  Those presenting for care with very low CD4 cell counts may make large demands on clinical resources, particularly over the first few months. While some patients do have a poor outcome on highly active antiretroviral therapy, many will benefit from this therapy and will experience good immunological and virological responses.
authors.affiliation: Royal Free and University College Medical School, Royal Free NHS Trust, London, UK. c.sabin@pcps.ucl.ac.uk
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
authors.forename: Colette J
authors.initials: CJ
authors.lastname: Smith
authors.forename: Helen
authors.initials: H
authors.lastname: Gumley
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Murphy
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Lampe
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
authors.forename: Beth
authors.initials: B
authors.lastname: Prinz
authors.forename: Mike
authors.initials: M
authors.lastname: Youle
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents