IMPACT OF LABORATORY-INITIATED REPORTING OF CD4(-LYMPHOCYTES ON US AIDS SURVEILLANCE() T)

This study was conducted to measure the impact of laboratory-initiated reporting of CD4(+) results on reporting of AIDS in the United States . States were categorized by whether CD4(+) reporting was required; we compared the number and percentage of AIDS cases reported based on im munologic criteria, controlling for whether states also required HIV i nfection reporting. We observed cases reported in 1994 with CD4(+) val ues and the delay between diagnosis and report by CD4(+) and HIV-repor ting status. From 1992 to 1994, states with CD4(+) reporting had a gre ater proportionate increase in reported AIDS cases (98%) than states w ithout CD4(+) report ing (55%; p < 0.0001). From 1993 to 1994, the eig ht states with both CD4(+) and HIV reporting had a higher increase in cases meeting immunologic criteria (7%) than the 13 states with only H IV reporting (<1%), the three states with only CD4(+) reporting (<1%), and the 16 states with neither form of laboratory reporting (4%). Of 1987 definition cases reported in 1994, the percentage reported with C D4(+) values was lower in states without either CD4(+) or HIV reportin g (79%) than in states with both CD4(+) and HIV reporting (83%), only HIV reporting (84%), or only CD4(+) reporting (88%). The percentage of AIDS cases reported within 3 months of diagnosis was lower in states without laboratory reporting (40%) than in states with CD4(+) reportin g (45%, p = 0.001). CD4(+) reporting may enable stales to report AIDS cases earlier in the course of HIV disease, permitting early targeting of health care and social services.