Trends in immunologic and clinical status of newly diagnosed HIV-positive patients initiating care in the HAART era

Objective: To evaluate whether the availability of highly active antiretrov iral therapy (HAART) has motivated people at risk for HIV infection to be t ested earlier. Methods: Data are from the Adult and Adolescent Spectrum of HIV Disease (AS D) Study, a chart review study of HIV-infected people receiving care. The s ample comprised newly diagnosed HIV-positive persons initiating care at fiv e ASD clinics in New York City (NYC) 1994 to 1999. CD4(+) lymphocyte count and clinical status (asymptomatic, major AIDS-related symptoms, AIDS-defini ng opportunistic illnesses) at first visit were ascertained. Trends in thes e two outcomes were analyzed comparing each time period after the second ha lf of 1996 with the aggregate period from 1994 to the first half of 1996. Results: Between 1994 and 1999, we identified 545 patients newly diagnosed as positive for HIV with a first visit to an ASD clinic. Patients were pred ominantly black or Hispanic (93%). The mean CD4(+) count at baseline was 24 6 cells/<(<mu>)over bar>l and the median was 152 cells/<(<mu>)over bar>l. A fter adjusting for covariates, the mean CD4(+) count of newly diagnosed HIV -positive patients was significantly lower (p = .04) only during the second half of 1997. The proportion of patients who were asymptomatic at baseline ranged from 29% in the second half of 1998 to 61% in the first half of 199 4 (chi (2) = 48.8; p = .0008). After adjustment for covariates, the probabi lity of a patient having a major symptom or an opportunistic illness at bas eline was significantly higher only during the second half of 1998 (p = .00 1). Discussion During most time periods, both before and after the introduction of HAART, most newly diagnosed patients at these five HIV clinics in NYC w ere immune suppressed and symptomatic.