title: Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study.
abstract: OBJECTIVE
  To investigate delayed HIV diagnosis and late initiation of antiretroviral therapy (ART) in the Swiss HIV Cohort Study.
  
  
  METHODS
  Two sub-populations were included: 1915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration (group A), and 1730 treatment-naïve patients with CD4>or=200 cells/microL before their second cohort visit (group B). In group A, predictors for low initial CD4 cell counts were examined with a median regression. In group B, we studied predictors for CD4<200 cells/microL without ART despite cohort follow-up.
  
  
  RESULTS
  Median initial CD4 cell count in group A was 331 cells/microL; 31% and 10% were <200 and <50 cells/microL, respectively. Risk factors for low CD4 count were age and non-White race. Homosexual transmission, intravenous drug use and living alone were protective. In group B, 30% initiated ART with CD4>or=200 cells/microL; 18% and 2% dropped to CD4 <200 and <50 cells/microL without ART, respectively. Sub-Saharan origin was associated with lower probability of CD4 <200 cells/microL without ART during follow-up. Median CD4 count at ART initiation was 207 and 253 cells/microL in groups A and B, respectively.
  
  
  CONCLUSIONS
  CD4<200 cells/microL and, particularly, CD4<50 cells/microL before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount.
authors.affiliation: Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Wolbers
authors.forename: H C
authors.initials: HC
authors.lastname: Bucher
authors.forename: H
authors.initials: H
authors.lastname: Furrer
authors.forename: M
authors.initials: M
authors.lastname: Rickenbach
authors.forename: M
authors.initials: M
authors.lastname: Cavassini
authors.forename: R
authors.initials: R
authors.lastname: Weber
authors.forename: P
authors.initials: P
authors.lastname: Schmid
authors.forename: E
authors.initials: E
authors.lastname: Bernasconi
authors.forename: B
authors.initials: B
authors.lastname: Hirschel
authors.forename: M
authors.initials: M
authors.lastname: Battegay
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000592:standards; D018450:Disease Progression; D004334:Drug Administration Schedule; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral