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-naive patients with CD4 >= 200 cells/mu L 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/mu L without ART despite cohort follow-up. Results Median initial CD4 cell count in group A was 331 cells/mu L; 31% and 10% were < 200 and < 50 cells/mu L, 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/mu L; 18% and 2% dropped to CD4 < 200 and < 50 cells/mu L without ART, respectively. Sub-Saharan origin was associated with lower probability of CD4 < 200 cells/mu L without ART during follow-up. Median CD4 count at ART initiation was 207 and 253 cells/mu L in groups A and B, respectively. Conclusions CD4 < 200 cells/mu L and, particularly, CD4 < 50 cells/mu L before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount.