title: Declines in highly active antiretroviral therapy initiation at CD4 cell counts ≤ 200 cells/μL and the contribution of diagnosis of HIV at CD4 cell counts ≤ 200 cells/μL in British Columbia, Canada.
abstract: OBJECTIVE
  The aim of the study was to examine trends in initiating highly active antiretroviral therapy (HAART) with a CD4 count ≤ 200 cells/μL and the contribution of having a CD4 count ≤ 200 cells/μL at the time of diagnosis to these trends, in British Columbia (BC), Canada.
  
  
  METHODS
  We included in the analysis treatment-naïve BC residents aged ≥ 19 years who initiated HAART from 2003 to 2012. Participants were classified as follows: Group 1: diagnosed and initiated HAART with a CD4 count > 200 cells/μL; Group 2: diagnosed with a CD4 count > 200 cells/μL and initiated HAART with a CD4 count ≤ 200 cells/μL; and Group 3: diagnosed and initiated HAART with a CD4 count ≤ 200 cells/μL. We measured trends in initiating HAART with a CD4 count ≤ 200 cells/μL and used logistic regression models to measure factors associated with initiating HAART with a CD4 count ≤ 200 cells/μL, stratified by having a CD4 count ≤ 200 cells/μL or > 200 cells/μL at the time of diagnosis.
  
  
  RESULTS
  Between 2003 and 2012, 3506 BC residents initiated HAART. Of these, 44% (1558 of 3506) initiated HAART with a CD4 count ≤ 200 cells/μL. This proportion declined from 69% (198 of 287) in 2003 to 21% (81 of 330) in 2012 (P < 0.001). The proportion of those in Group 3 increased from 49% (97 of 198) in 2003 to 69% (56 of 81) in 2012 (P < 0.001). Overall, 56% (1948), 22% (776) and 22% (782) made up Groups 1, 2, and 3, respectively. In adjusted analyses, seeing a specialist was significantly associated with being in Group 3. Using injection drugs and seeing a specialist were associated with being in Group 2.
  
  
  CONCLUSIONS
  In recent years, among individuals who ever initiated HAART in BC, being diagnosed with low CD4 cell counts has become a greater contributor to initiating HAART with low CD4 cell counts.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Lourenço
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: H
authors.identifier: http://orcid.org/0000-0002-4555-7609
authors.initials: H
authors.lastname: Samji
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Nohpal
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Chau
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Colley
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Lepik
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Barrios
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Lima
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: R S
authors.initials: RS
authors.lastname: Hogg
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jsg
authors.initials: J
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Kesselring
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: D M
authors.initials: DM
authors.lastname: Moore
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000639:trends*; D001955:British Columbia; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: HIV; diagnosis; highly active antiretroviral therapy; late initiation; late presentation