AEGiS-13IAC: National CD4 surveillance in England and Wales: the utility of CD4 cell counts in monitoring a treatment effect at the population level in HIV infected individuals.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

National CD4 surveillance in England and Wales: the utility of CD4 cell counts in monitoring a treatment effect at the population level in HIV infected individuals.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC724)

Gupta S, Dingley SD, Evans BG
S. Gupta, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, United Kingdom, Tel.: +44 181 200 6868, Fax: +44 181 200 7868, E-mail: sgupta@phls.nhs.uk

BACKGROUND: in 1995, a national CD4 surveillance scheme was initiated with the participation of 55 laboratories throughout England and Wales in order to monitor trends in immunosuppression in HIV infected adults.

METHODS: Adults with diagnosed HIV infection between 1990 and 1999 who had a record in the CD4 database of an initial count measured within six months of HIV diagnosis were identified. The distribution of initial counts was determined and each year cohort of newly diagnosed persons was followed over time to examine trends in their median CD4 counts.

RESULTS: We identified 10,007 adults diagnosed with HIV infection between 1990 and 1999 who had an initial CD4 count measured within six months of diagnosis. The percentage of persons diagnosed with initial CD4 counts below 200 cells/mm³ , indicating advanced disease, or above 700 cells/mm³ , indicating more recent acquisition of HIV infection, remained relatively stable. Throughout the time period examined, over 50% of newly diagnosed persons had counts below 350 cells/mm³ , the level regarded by the British HIV Association at which antiretroviral therapy should have already begun. For each year cohort, median count in subsequent years decreased until 1996 and then increased thereafter for all but one cohort in one year.

CONCLUSIONS: The results indicate that there is evidence of a treatment effect in the general HIV-infected population in England and Wales. However, even though highly active anti-retroviral therapy (HAART) is now more widely available, a large number of persons are diagnosed late in the progression of clinical disease. The benefits of HAART seen in clinical trials can now be seen at the population level; therefore, prompt diagnosis and appropriate initiation of therapy is essential and should be emphasised.

Keywords: AEGIS, CD4 Lymphocyte Count, HIV Infections, Antiretroviral Therapy, Highly Active, England, Wales, Federal Government, HIV Seropositivity, Drug Therapy, Combination, Population, Population Surveillance, Adult, therapy, Epidemiology, drug therapy
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ThOrC724