title: Factors associated with the level of CD4 cell counts at HIV diagnosis in a French cohort: a quantile regression approach.
abstract: The consensus definition of late presentation for human immunodeficiency virus patient based on a CD4 threshold of 350 cells/mm3has limitations concerning risk factors identification since there is growing biomedical justification for earlier initiation of treatment. The objective was to overcome this problem by simultaneously determining factors associated with different levels of CD4 counts at the time of diagnosis. Between January 2000 and July 2014, 1179 patients with a first human immunodeficiency virus diagnosis and entering care in a French human immunodeficiency virus reference center were enrolled. Factors associated with each 5 percentile from 5th to 95th quantile of CD4 counts at diagnosis were simultaneously studied in a multivariable quantile regression model. At each of the quantiles, the factors identified as negatively associated with CD4 count at diagnosis were older age, male sex , foreign patients, hepatitis B virus or hepatitis C virus co-infection, employment status, non-MSM transmission, heterosexual transmission, suburban and rural's place of residence and earlier period of diagnosis. Association with CD4 count was not uniformly significant, most factors being significant for some quantiles. The only significant determinant for all quantiles was being born in a foreign country. These results are particularly helpful in the context of human immunodeficiency virus clinical care, management and prevention.
authors.affiliation: 1 Regional Coordination Center for the Fight against HIV (COREVIH) of Pays de la Loire, Nantes, France.|2 Methodological Support and Biostatistics Unit, Saint Denis University Hospital, Saint Denis, Reunion Island, France.
authors.forename: Léa
authors.initials: L
authors.lastname: Bruneau
authors.affiliation: 1 Regional Coordination Center for the Fight against HIV (COREVIH) of Pays de la Loire, Nantes, France.|3 Infectious and Tropical Diseases Department, Nantes University Hospital, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Billaud
authors.affiliation: 3 Infectious and Tropical Diseases Department, Nantes University Hospital, Nantes, France.
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.affiliation: 4 National Institute of Health and Medical Research (INSERM) CIC 1413, Nantes University Hospital, Nantes, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Hanf
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection; D057210:Delayed Diagnosis; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: CD4 counts; France; HIV/AIDS; late diagnosis; quantile regression