Infectious Diseases Society of America (IDSA)’nın düzenlediği IDWeek 2015™’te sunulan bir araştırmaya göre, tanı konulduğu sıradaki CD4+ T hücre sayılarının düşük bulunması, HIV taramalarının seyrek yapılmasıyla bağlantılı olabilir.
SAN DIEGO — Infrequent HIV screening could be associated with lower initial counts of CD4+ T cells among diagnosed patients, according to research presented here.
“Lower CD4 counts at time of HIV diagnosis have been attributed to infrequent testing and delays in care,” Catherine Berjohn, MD, MPH, of the infectious diseases division at Naval Medical Center San Diego, said during a presentation. “We know that lower CD4 counts increase the risk of transmission, likely because of the association with higher viral loads, but also because of an increased risk of opportunistic infections and mortality.”
Berjohn and colleagues respectively examined 1,258 participants enrolled in the U.S. Military HIV Natural History Study who were infected during service from 2000 to 2014. Participants (median age, 27 years) were predominately male, black (43%), white (37%) and Latino (13%). Mean and median CD4 cell counts were recorded at diagnosis. These were compared among various intervals of HIV testing by multivariable regression analysis while controlling for other factors such as calendar year, age, gender, race, age and viral load.
“The actual window of seroconversion has been difficult to characterize in the general population, with the exception of acute HIV seroconversion cases,” Berjohn said. “U.S. military service members are subject to mandated screening at relevant intervals, however, and … for this group of people, we can isolate a window of seroconversion.”
Among the participants, 76.6% of those diagnosed had received their most recent negative result within 2 years, and 40.3% had received a negative result within 1 year. Mean initial CD4 count was 466 cells/µL, but decreased when examining patients whose previous negative result was 1 to 2 years previous, and further decreased among those whose previous negative was more than 2 years earlier. As a result, longer intervals were associated with decreasing CD4 counts (P < .001), and remained significant when controlling for calendar year. In addition, participants whose last negative diagnosis was more than 2 years previous had twice the rate of AIDS diagnosis by CD4 criteria than those who were tested more frequently (P < .027). Similar associations were observed among nonwhite participants, but no relationships were seen concerning viral load and calendar year.
“Early treatment leads to better outcomes overall, with a decrease in reservoir seeding, increase in CD4 recovery potential, decreased effects of chronic inflammatory state and decreased risk of transmission,” Berjohn said. “There’s no reason why these findings wouldn’t be generalizable to the entire U.S. population; however, it may be a bit prohibitive to implement this kind of screening program. But, for closed systems of health care … it may be an interesting option to examine.” – by Dave Muoio
Berjohn C, et al. Abstract 118. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.
Disclosure: The researchers report no relevant financial disclosures.