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HIV Cascade in NYC 2006-2012 - Increase in CD4+ T-Cell Count at the Time of HIV Diagnosis and Antiretroviral Treatment Initiation Among Persons With HIV in New York City
 
 
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Abstract
 
Background.
Trends in CD4+ T-cell count at human immunodeficiency virus (HIV) infection diagnosis and antiretroviral therapy (ART) initiation can be characterized using laboratory tests from surveillance.
 
Methods. We used CD4+ T-cell counts and viral loads from New York City for persons who received a diagnosis of HIV infection during 2006–2012.
 
Results. From 2006 to 2012, the median CD4+ T-cell count increased from 325 to 379 cells/μL at diagnosis and from 178 to 360 cells/μL at ART initiation. CD4+ T-cell counts were consistently lower in women, blacks, Hispanics, persons who inject drugs, and heterosexuals.
 
Discussion. Increases in CD4+ T-cell count at diagnosis and ART initiation suggest that the time from HIV infection to ART initiation has been reduced substantially in New York City.
 
RESULTS
 
Analytic Population

 
A total of 24 346 persons had a new diagnosis of HIV infection from 1 January 2006 to 31 December 2012 in New York City (Supplementary Figure 1). Of these, 21 948 (90%) were ever linked to care after diagnosis. Of the 21 948 persons linked to care, CD4+ T-cell counts for 17 733 (81%) were obtained within 6 months of diagnosis. The remaining 4215 persons did not have a CD4+ T-cell count within 6 months of diagnosis. Among persons with a CD4+ T-cell count obtained within 6 months of diagnosis, 14 311 (81%) had evidence of probable ART initiation. Finally, 13 022 persons who initiated ART during the analytic period had a CD4+ T-cell count obtained within 3 months of ART initiation. Among this group, 10 192 persons (78%) initiated ART within 12 months of diagnosis.
 
Demographic Characteristics and CD4+ T-Cell Count Distribution
 
The majority of persons in the study population were male, aged 20–29 years, black or Hispanic, and men who have sex with men (MSM), similar to the overall profile of persons with a new diagnosis of HIV infection during this period (Table 1) [8].
 
Median CD4+ T-cell count among persons who received a diagnosis from 1 January 2006 to 31 December 2012 in New York City was 354 cells/μL (Table 1). Median CD4+ T-cell count at diagnosis decreased with increasing age at diagnosis. Men had a higher median CD4+ T-cell count at diagnosis than women, and whites had a higher median CD4+ T-cell count at diagnosis than blacks, Hispanics, Asian/Pacific Islanders, and Native Americans. By transmission risk group, MSM had the highest CD4+ T-cell count at diagnosis. Over the entire analytic period, 59% of persons (14 311 of 24 358) who received a new diagnosis of HIV infection in New York City and had a CD4+ T-cell count reported within 6 months of diagnosis initiated ART; median CD4+ T-cell count at ART initiation among persons who received a new diagnosis during this period was 297 cells/μL. Differences in median CD4+ T-cell count at ART initiation across demographic subgroups were similar to subgroup differences in median CD4+ T-cell count at diagnosis.
 
During this period, the median CD4+ T-cell count at ART initiation, by year of diagnosis, increased from 249 cells/μL in 2006 to 352 cells/μL in 2012 (mean increase, 14.7 cells/μL per year; Figure 1). Among persons who initiated ART within 12 months of diagnosis, the median CD4+ T-cell count at ART initiation by year of diagnosis increased more dramatically, from 199.5 cells/μL in 2006 to 352 cells/μL in 2012 (mean, 21.8 cells/μL per year).
 
By year of ART initiation, the median CD4+ T-cell count at ART initiation increased from 178 cells/μL in 2006 to 402 cells/μL in 2013 (mean, 28 cells/μL per year; Table 1). Over half (56%) of persons who initiated ART in 2012 received a diagnosis that same year, compared with 48% in 2006 (data not shown).
 
All demographic and risk subgroups experienced increases in the median CD4+ T-cell count at diagnosis and ART initiation during 1 January 2006 to 31 December 2013 (Supplementary Figure 2). However, the median CD4+ T-cell counts were consistently lower for women, blacks, Hispanics, persons with a history of injection drug use, and heterosexuals, and there was a downward trend in recent years for persons with a history of injection drug use. Black or Hispanic MSM had lower median CD4+ T-cell counts at diagnosis and ART initiation compared with white MSM.

 
 
 
 
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