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Most People With HIV Begin Care Too Late

Average T-cell count at first treatment is below recommended level for starting therapy, study shows

FRIDAY, June 4 (HealthDay News) -- Americans and Canadians infected with HIV are not getting diagnosed quickly enough after exposure, resulting in a potentially harmful delay in lifesaving treatment, a new large study suggests.

The observation stems from an analysis involving nearly 45,000 HIV-positive patients in both countries, which focused on a key yardstick for immune system strength -- CD4 cell counts -- at the time each patient first began treatment.

CD4 counts measure the number of "helper" T-cells that are HIV's preferred target.

Reviewing the participants' medical records between 1997 and 2007, the team found that throughout the 10-year study period, the average CD4 count at the time of first treatment was below the recommended level that scientists have long identified as the ideal starting point for medical care.

"The public health implications of our findings are clear," study author Dr. Richard Moore, from the Johns Hopkins University School of Medicine in Baltimore, said in a news release. "Delayed diagnosis reduces survival, and individuals enter into HIV care with lower CD4 counts than the guidelines for [initiating] antiretroviral therapy." A delay in getting treatment not only increases the chance that the disease will progress, but boosts the risk of transmission, he added.

Despite the fact that the average CD4 count at time of first presentation to care had risen over the course of the decade from 256 to 317, the researchers noted that even the high point was still below the treatment threshold of 350. Moore and his team also found that the average age at which patients had first sought care for HIV had risen over the ten-year period, from 40 to 43.

Writing in an editorial that accompanied the study, Dr. Cynthia Gay of the University of North Carolina at Chapel Hill expressed concern over the findings.

"These findings reveal that despite such compelling data, there is much room for improving our ability to link more HIV-infected individuals with effective treatment prior to immunological deterioration," she said in a news release.

Moore and his colleagues report their findings in the June 1 issue of Clinical Infectious Diseases.

More information

For more on HIV diagnosis, treatment, and CD4 counts visit the N.Y. State Department of Health.

-- Alan Mozes

SOURCE:Clinical Infectious Diseases, May 28, 2010, news release

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