Infect Chemother.  2017 Jun;49(2):101-108. 10.3947/ic.2017.49.2.101.

Trend of CD4+ Cell Counts at Diagnosis and Initiation of Highly Active Antiretroviral Therapy (HAART): Korea HIV/AIDS Cohort Study, 1992-2015

• Kim MJ
• Chang HH
• Kim SI
• Kim YJ
• Park DW
• Kang C
• Kee MK
• Choi JY
• Kim SM
• Choi BY
• Kim WJ
• Kim JM
• Choi JY
• Choi YH
• Lee JS
• Kim SW
• Korea HIV/AIDS Cohort Study

• KMID: 2383930
• DOI: http://doi.org/10.3947/ic.2017.49.2.101

Abstract

BACKGROUND
CD4+ cell counts reflect immunologic status of human immunodeficiency virus (HIV) patients. Recommended CD4+ cell counts for the initiation of highly active antiretroviral therapy (HAART) has increased over the past several years in various HIV treatment guidelines. We investigated the trend of CD4+ cell counts at diagnosis and treatment start using data from the Korea HIV/acquired immune deficiency syndrome (AIDS) Cohort Study.
MATERIALS AND METHODS
The Korea HIV/AIDS Cohort Study started in 2006 and enrolled HIV patients from 21 tertiary and secondary hospitals in South Korea. The data for CD4+ cell counts at diagnosis and HAART initiation from these HIV patients were analyzed by three-year time intervals and presented by number of CD4+ cells (≤100, 101-200, 201-350, 351-500 and >500 cells/mm³). The HIV-RNA titer at diagnosis and HAART initiation were presented by 3-year intervals by groups ≤50,000, 50,001-100,000, 100,001-200,000, 200,001-1,000,000, and >1,000,000 copies/mL.
RESULTS
Median values of CD4+ cell count and HIV-RNA titer at initial HIV diagnosis were 247 cells/mm³ and 394,955 copies/mL, respectively. At time of initiating HAART, median values of CD4+ cell count and HIV-RNA were 181 cells/mm³ and 83,500 copies/mL, respectively. Patients with low CD4+ cell count (CD4+ cell count ≤200 cells/mm³) at diagnosis (31-51%) and initiation of HAART accounted for the largest proportion (30-65%) over the three-year time intervals. This proportion increased until 2010-2012.
CONCLUSION
CD4+ cell count at initiation of HAART was found to be very low, and the increase in late initiation of HAART in recent years is of concern. We think that this increase is primarily due to an increasing proportion of late presenters. We recommend early detection of HIV patients and earlier start of HAART in order to treat and prevent spread of HIV infection.

Keyword

Human immunodeficiency virus; Cohort Study; CD4+ Lymphocyte Count

MeSH Terms

Antiretroviral Therapy, Highly Active*
CD4 Lymphocyte Count*
Cell Count
Cohort Studies*
Diagnosis*
HIV
HIV Infections
Humans
Korea*

Figure

• 

  Figure 1 The trend of CD4+ cell count at the time of diagnosis by 3-year intervals. As of 2015, a total of 1,124 HIV-infected patients were included. Each period was stratified by grade of CD4+ cell count: ≤100, 101-200, 201-350, 351-500, and >500 cells/mm3. Values are presented as number (percentage).

• 

  Figure 2 The trend of HIV-RNA titer at the time of diagnosis by 3-year intervals. As of 2015, a total of 1,079 HIV-infected patients were included. Each period was stratified by the level of HIV-RNA titer: ≤50,000, 500,001-100,000, 100,001-200,000, 200,001-1,000,000, and >1,000,000 copies/mL. Values are presented as number (percentage).

• 

  Figure 3 The trend of CD4+ cell count at the time of initiating highly active antiretroviral therapy by 3-year intervals. As of 2015, 376 HIV patients were included. CD4+ cell count, ≤100, 101-200, 201-350, 351-500, and >500 cells/mm3, is stratified for each time interval. Values are presented as number (percentage).

• 

  Figure 4 The trend of HIV-RNA titer at the time of initiating highly active antiretroviral therapy by three-year intervals. As of 2015, 322 HIV patients were included. Level of HIV-RNA: ≤50,000; 50,001-100,000; 100,001-200,000; 200,001-1,000,000; and >1,000,000 copies/mL is stratified for each time interval. Values are presented as number (percentage).

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