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New Entrants to HIV Care Are Presenting Only at Marginally Earlier Stages of Disease but May Increasingly Represent Groups Perceived at Lower Risk

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Michael M. Lederman, MD

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Hernán Valdez, MD

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgebury, Conn

Robert A. Salata, MD

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Grace A. McComsey, MD

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Barbara Gripshover, MD

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Scott Fulton, MD

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Michelle V. Lisgaris, MD

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Michelle Kucia

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Robert Asaad, MD

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Jennifer Cline

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio

Benigno Rodríguez, MD, MSc

Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio, Rodriguez.benigno{at}clevelandactu.org

Background : Treatment has improved HIV infection prognosis, but whether risk and health care seeking behavior have improved is unclear. Methods: New entrants to HIV care at University Hospitals of Cleveland, Ohio, between 1995 and 2002, with no history of AIDS-defining illnesses or antiretroviral exposure were included. Results: Of new patients, 806 (80%) met the inclusion criteria. Median age increased during the study period(35.2 to 38.6 years; P < .001); proportions of females and non-whites increased nonsignificantly. Prevalence of AIDS-defining illnesses decreased from 1995 to 1996 (25.0% to 14.2%; P <.001) but remained stable thereafter. Category B conditions and sexually transmitted diseases decreased significantly(31.7% to 9.1%; P = .039 and 22.5% to 8.0%; P = .003), as did hepatitis B and C seroprevalence (8.3% to 3.6%; P = .05 and 26.2% to 14.3%; P = .003). Median CD4 counts and HIV RNA did not change significantly. Conclusions: Prevalence of Category B conditions, sexually transmitted diseases, and hepatitis B and C declined significantly in this study. Prevalence of AIDS-defining illnesses decreased early in the highly active antiretroviral therapy era only, whereas markers of HIV disease stage remained stable, suggesting a need for earlier recognition of infection. Decreasing sexually transmitted diseases and hepatitis coinfections suggest that HIV infection is increasingly seen in populations previously perceived at lower risk.

Key Words: HIV infection • HIV testing • HIV epidemiology • viral hepatitis

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 4, No. 2, 47-51 (2005)
DOI: 10.1177/1545109705278112


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