New entrants to HIV care are presenting only at marginally earlier stages of disease but may increasingly represent groups perceived at lower risk.
BACKGROUND
Treatment has improved HIV infection prognosis, but whether risk and health care seeking behavior have improved is unclear.


METHODS
New entrants to HIV care at University Hospitals of Cleveland, Ohio, between 1995 and 2002, with no history of AIDS-defining illnesses or antiretroviral exposure were included.


RESULTS
Of new patients, 806 (80%) met the inclusion criteria. Median age increased during the study period(35.2 to 38.6 years; P < .001); proportions of females and non-whites increased nonsignificantly. Prevalence of AIDS-defining illnesses decreased from 1995 to 1996 (25.0% to 14.2%; P <.001) but remained stable thereafter. Category B conditions and sexually transmitted diseases decreased significantly(31.7% to 9.1%; P = .039 and 22.5% to 8.0%; P = .003), as did hepatitis B and C seroprevalence (8.3% to 3.6%; P = .05 and 26.2% to 14.3%; P = .003). Median CD4 counts and HIV RNA did not change significantly.


CONCLUSIONS
Prevalence of Category B conditions, sexually transmitted diseases, and hepatitis B and C declined significantly in this study. Prevalence of AIDS-defining illnesses decreased early in the highly active antiretroviral therapy era only, whereas markers of HIV disease stage remained stable, suggesting a need for earlier recognition of infection. Decreasing sexually transmitted diseases and hepatitis coinfections suggest that HIV infection is increasingly seen in populations previously perceived at lower risk.
Loupa
Chariclia V
CV
Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio 44106, USA.
Lederman
Michael M
MM
Valdez
Hernán
H
Salata
Robert A
RA
McComsey
Grace A
GA
Gripshover
Barbara
B
Fulton
Scott
S
Lisgaris
Michelle V
MV
Kucia
Michelle
M
Asaad
Robert
R
Cline
Jennifer
J
Rodríguez
Benigno
B
D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D019538:Health Care Surveys; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D009820:Ohio; D010342:Patient Acceptance of Health Care; D018570:Risk Assessment; D012749:Sexually Transmitted Diseases / Q000150:complications