Temporal trends in postseroconversion CD4 cell count and HIV load: The Concerted Action on Seroconversion to AIDS and Death in Europe Collaboration, 1985-2002

Objective. To determine whether early postseroconversion CD4 cell counts and human immunodeficiency virus (HIV) loads have changed over time. Methods. Our analysis was based on 22 cohorts of people with known dates of seroconversion from Europe, Australia, and Canada (Concerted Action on Seroconversion to AIDS and Death in Europe Collaboration). We focused on individuals seroconverting between 1985 and 2002 who had the first CD4 cell count (n = 3687) or HIV load (n = 1584) measured within 2 years of seroconversion and before antiretroviral use. Linear regression models were used to assess time trends in postseroconversion CD4 cell count and HIV load. Trends in time to key thresholds were also assessed, using survival analysis. Results. The overall median initial CD4 cell count was 570 cells/mu L (interquartile range [IQR], 413-780 cells/mL). The median initial HIV load was 35,542 copies/mL (IQR, 7600-153,050 copies/mL; on log 10 scale, 3.9-5.2 log 10 copies/mL). The postseroconversion CD4 cell count changed by an average of-6.33 cells/mL/year (95% kconfidence interval [CI],-8.47 to-4.20 cells/mL/year; P < .001), whereas an increase was observed in log 10 HIV load (+ 0.044 log(10) copies/mL/year; 95% CI, + 0.034 to + 0.053 log(10) copies/mL/year). These trends remained after adjusting for potential confounders. The probability of progressing to a CD4 cell count of ! 500 cells/mL by 24 months from seroconversion increased from 0.66 (95% CI, 0.63-0.69) for individuals who seroconverted before 1991 to 0.80 (95% CI, 0.75-0.84) for those who seroconverted during 1999-2002. Conclusion. These data suggest that, in Europe, there has been a trend of decrease in the early CD4 cell count and of increase in the early HIV load. Additional research will be necessary to determine whether similar trends exist in other geographical areas.