title: Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era.
abstract: BACKGROUND
  Earlier HIV diagnosis and engagement in care improve outcomes and is cost effective, as a result, in 2006, the Centers for Disease Control and Prevention (CDC) revised the HIV-screening guidelines. We sought to determine whether the CD4 count (CD4) at presentation, a surrogate for time to presentation, increased during the study period. Our a priori hypothesis was that the CD4 at presentation increased during the study period, particularly after the CDC guideline revision.
  
  
  METHODS
  We performed a retrospective cohort study and analyzed data from the HIV Research Network, a consortium of 18 US clinics caring for HIV-infected patients. HIV-infected adults (≥18 years old) newly presenting for care between 2003 and 2011 were included in this study. Multivariable linear regression examined associations with CD4 at enrollment. Calendar year was modeled as a linear spline with a change in slope at 2008, allowing determination of the mean change in CD4 per year during 2003-2007 and 2008-2011.
  
  
  RESULTS
  Over 13,543 newly presenting subjects enrolled from 2003 to 2011. Median CD4 at enrollment rose from 285 to 317 cells per cubic millimeter between 2003-2007 and 2008-2011 (P < 0.001). After adjusting for age, race/ethnicity, gender, HIV risk factor, and clinic site, the mean increase in the CD4 count at presentation per year was 13.3 cells per cubic millimeter per year (95% confidence interval 6.4 to 20.1 cells per cubic millimeter per year) greater during 2008-2011 than during 2003-2007.
  
  
  CONCLUSIONS
  We demonstrate a small, but statistically significant, increase in CD4 at presentation after the CDC guideline revision. More efforts are needed to decrease time to presentation to HIV care.
authors.affiliation: *Division of Infectious Diseases, Department of Medicine, The Johns Hopkins of Medicine, Baltimore, MD; †Agency for Healthcare Research and Quality (AHRQ); ‡Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and §Jonathan Lax Treatment Center, Philadelphia, PA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Haines
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Berry
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Laura P
authors.initials: LP
authors.lastname: Bamford
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral