Background. It is unclear if CD4 cell counts at HIV diagnosis have improved over a 10-year period of expanded HIV testing in the USA. Methods. We studied HOPS participants diagnosed with HIV infection ≤6 months prior to entry into care during 2000–2009. We assessed the correlates of CD4 count <200 cells/mm3 at HIV diagnosis (late HIV diagnosis) by logistic regression. Results. Of 1,203 eligible patients, 936 (78%) had a CD4 count within 3 months after HIV diagnosis. Median CD4 count at HIV diagnosis was 299 cells/mm3 and did not significantly improve over time ( ). Comparing periods 2000-2001 versus 2008-2009, respectively, 39% and 35% of patients had a late HIV diagnosis ( ). Independent correlates of late HIV diagnosis were having an HIV risk other than being MSM, age ≥35 years at diagnosis, and being of nonwhite race/ethnicity. Conclusions. There is need for routine universal HIV testing to reduce the frequency of late HIV diagnosis and increase opportunity for patient- and potentially population-level benefits associated with early antiretroviral treatment. 1. Introduction Recent HIV surveillance data suggest that approximately 33% of HIV-infected persons in the United States present for HIV testing late and have AIDS (CD4+ cell count <200？cells/mL or an AIDS-defining illness) within one year after HIV diagnosis [1, 2]. Patients are less likely to experience the full benefits of highly active combination antiretroviral (cART) therapy if they enter HIV care and initiate treatment at a CD4 count <350？cells/mm3 [3, 4]; the clinical cost is even more profound when the CD4 count is <200？cells/mm3 or the patient has already developed clinical AIDS [5–8]. In addition, persons who remain unaware of their HIV-positive status (estimated 21% to 25% of infected persons in the USA in recent years) [9, 10] may not only miss the benefits of earlier cART treatment, but are also more likely to remain chronically viremic and are thereby more likely to transmit HIV to their sexual and needle-sharing partners . The CDC has been promoting strategies to encourage more widespread HIV screening to diagnose infected persons earlier in the course of their illness, including by releasing in 2006 the guidelines for implementing routine universal opt-out testing in healthcare settings . Yet, the latest HIV surveillance data [1, 2] and epidemiologic studies in multiple US populations indicate that the proportion of persons who are diagnosed late in the course of HIV infection [2, 12, 13] or present late for HIV care [14, 15] remains unacceptably high. Stable or worsening
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