Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Objectives: To investigate delayed HIV diagnosis and late initiation of antiretroviral therapy (ART) in the Swiss HIV Cohort Study. Methods: Two sub-populations were included: 1915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration (group A), and 1730 treatment-naïve patients with CD4 ≥ 200 cells/μL before their second cohort visit (group B). In group A, predictors for low initial CD4 cell counts were examined with a median regression. In group B, we studied predictors for CD4 < 200 cells/μL without ART despite cohort follow-up. Results: Median initial CD4 cell count in group A was 331 cells/μL; 31% and 10% were < 200 and < 50 cells/μL, respectively. Risk factors for low CD4 count were age and non-White race. Homosexual transmission, intravenous drug use and living alone were protective. In group B, 30% initiated ART with CD4 ≥ 200 cells/μL; 18% and 2% dropped to CD4 < 200 and < 50 cells/μL without ART, respectively. Sub-Saharan origin was associated with lower probability of CD4 < 200 cells/μL without ART during follow-up. Median CD4 count at ART initiation was 207 and 253 cells/μL in groups A and B, respectively. Conclusions: CD4 < 200 cells/μL and, particularly, CD4 < 50 cells/μL before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount. © 2008 British HIV Association.