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CD4 count at presentation for HIV care in the United States and Canada: Are those over 50 years more likely to have a delayed presentation?

  • Author(s): Althoff, Keri N
  • Gebo, Kelly A
  • Gange, Stephen J
  • Klein, Marina B
  • Brooks, John T
  • Hogg, Robert S
  • Bosch, Ronald J
  • Horberg, Michael A
  • Saag, Michael S
  • Kitahata, Mari M
  • Eron, Joseph J
  • Napravnik, Sonia
  • Rourke, Sean B
  • Gill, M John
  • Rodriguez, Benigno
  • Sterling, Timothy R
  • Deeks, Steven G
  • Martin, Jeffrey N
  • Jacobson, Lisa P
  • Kirk, Gregory D
  • Collier, Ann C
  • Benson, Constance A
  • Silverberg, Michael J
  • Goedert, James J
  • McKaig, Rosemary G
  • Thorne, Jennifer
  • Rachlis, Anita
  • Moore, Richard D
  • Justice, Amy C
  • et al.
Abstract

Abstract We assessed CD4 count at initial presentation for HIV care among ≥50-year-olds from 1997-2007 in 13 US and Canadian clinical cohorts and compared to <50-year-olds. 44,491 HIV-infected individuals in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) were included in our study. Trends in mean CD4 count (measured as cells/mm3) and 95% confidence intervals ([,]) were determined using linear regression stratified by age category and adjusted for gender, race/ethnicity, HIV transmission risk and cohort. From 1997-2007, the proportion of individuals presenting for HIV care who were ≥50-years-old increased from 17% to 27% (p-value < 0.01). The median CD4 count among ≥50 year-olds was consistently lower than younger adults. The interaction of age group and calendar year was significant (p-value <0.01) with both age groups experiencing modest annual improvements over time (< 50-year-olds: 5 [4 , 6] cells/mm3; ≥50-year-olds: 7 [5 , 9] cells/mm3), after adjusting for sex, race/ethnicity, HIV transmission risk group and cohort; however, increases in the two groups were similar after 2000. A greater proportion of older individuals had an AIDS-defining diagnosis at, or within three months prior to, first presentation for HIV care compared to younger individuals (13% vs. 10%, respectively). Due to the increasing proportion, consistently lower CD4 counts, and more advanced HIV disease in adults ≥50-year-old at first presentation for HIV care, renewed HIV testing efforts are needed.

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