title: New entrants to HIV care are presenting only at marginally earlier stages of disease but may increasingly represent groups perceived at lower risk.
abstract: 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.
authors.affiliation: Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio 44106, USA.
authors.forename: Chariclia V
authors.initials: CV
authors.lastname: Loupa
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lederman
authors.forename: Hernán
authors.initials: H
authors.lastname: Valdez
authors.forename: Robert A
authors.initials: RA
authors.lastname: Salata
authors.forename: Grace A
authors.initials: GA
authors.lastname: McComsey
authors.forename: Barbara
authors.initials: B
authors.lastname: Gripshover
authors.forename: Scott
authors.initials: S
authors.lastname: Fulton
authors.forename: Michelle V
authors.initials: MV
authors.lastname: Lisgaris
authors.forename: Michelle
authors.initials: M
authors.lastname: Kucia
authors.forename: Robert
authors.initials: R
authors.lastname: Asaad
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cline
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodríguez
mesh_terms: 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