title: Lower mortality and earlier start of combination antiretroviral therapy in patients tested repeatedly for HIV than in those with a positive first test.
abstract: BACKGROUND
  Early diagnosis of HIV-1 infection will probably beneficially impact onward transmission and life expectancy. We compared mortality rates and CD4 cell counts at start of combination antiretroviral therapy (cART) in patients with different frequencies of diagnostic testing for HIV.
  
  
  METHODS
  Patients infected with HIV-1 through sexual contact and in follow-up anytime from 2004 through 2008 were selected from the AIDS Therapy Evaluation in the Netherlands national observational HIV cohort and stratified into three groups: patients without a prior negative HIV antibody test (i.e., with a positive first-test result); patients with 1-2 years between the last negative and first positive test; and patients with less than 1 year between tests. Outcome measures were mortality from 2004 through 2008 and CD4 cell count at cART initiation.
  
  
  RESULTS
  Of 5494 patients, the mortality rate was highest among the 4067 patients with a positive first test (1.33/100 person-years) and the adjusted relative risk of mortality was 0.50 in 561 patients with tests 1-2 years apart (P = 0.04 compared to patients with a positive first test) and 0.49 (P = 0.02) when tests were less than 1 year apart (n = 866). In patients with a positive first test, 48% had CD4 cell counts less than 200 cells/μl at cART initiation; this proportion was 23-26% in the two groups of repeatedly tested patients (adjusted odds ratio compared to patients with a positive first test 0.43 and 0.37, respectively; both P < 0.0001).
  
  
  CONCLUSIONS
  Frequent repeated testing for HIV may improve the rate of timely diagnosis and treatment, thereby preventing disease progression.
authors.affiliation: Stichting HIV Monitoring, Academic Medical Center, Amsterdam, The Netherland. l.a.gras@amc.uva.nl
authors.forename: Luuk
authors.initials: L
authors.lastname: Gras
authors.forename: Ard
authors.initials: A
authors.lastname: van Sighem
authors.forename: Daniela
authors.initials: D
authors.lastname: Bezemer
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Wit
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents