July 12, 2004
This retrospective study looks at all 677 patients newly diagnosed with HIV who attended a clinic at the Royal Free Hospital in London between January 1996 and December 2002 and compares late presenters (those with an initial CD4+ cell count of <50 at their first clinic visit) and non-late presenters (those with an initial CD4+ cell count of >50 at their first clinic visit). One hundred late presenters (14.8%) were identified.
The researchers found that the late presenters were more likely to be older (age 36 vs. 33), female (33% vs. 24%), heterosexual (50% vs. 37%), and black African (39% vs. 27%). The majority (57%) of late presenters had an AIDS diagnosis compared to only 7% of the non-late presenters. Late presenters commonly had Pneumocystis carinii pneumonia, while tuberculosis and Kaposi's sarcoma were more common in non-late presenters. Fifty-two late presenters were hospitalized at least once.
Eighty-nine of the late presenters started HAART: 48% received a protease inhibitor and 35% received a non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimen. The majority of patients who did not start HAART actually did not have the chance to do so because they died shortly after their first clinic visit. However, patients who survived long enough to receive HAART actually did quite well -- 85% had an undetectable viral load (below 400 copies/mL) and the median CD4+ cell count increased from 22 to 180 cells/mm3 over a year.
The risk factors for the late presenters in this study, which, as mentioned, were identified as being older, heterosexual, black African and female, reflect a trend in new HIV cases in the United States. Current preventive programs, including both early HIV testing and education, should strongly target this population. The good news is that despite their late diagnoses, the patients with a low CD4+ cell count who survived OIs to receive HAART responded well both virologically and immunologically.
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