Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA.
Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA.
Curr HIV/AIDS Rep. 2019 Aug;16(4):304-313. doi: 10.1007/s11904-019-00452-7.
Early diagnosis and treatment of HIV following seroconversion improves individual and population health. Using published data on pre-treatment CD4 cell counts, we benchmarked the level of immunodeficiency at HIV diagnosis and ART initiation in the "real world" against those of the treatment and control arms of landmark controlled trials that successfully reduced HIV-related deaths (INSIGHT/START) and onward HIV transmission (HPTN 052).
The median CD4 count in the treatment vs. control arms of the INSIGHT/START trial and HPTN 052 were 650 vs. 408 cells/μL and 442 vs. 221 cells/μL, respectively. In the real world, recent global estimates of the median CD4 count at start of ART range from 234 to 350 cells/μL, and only 25% of those initiating ART do so early (i.e., with CD4 > 500 cells/μL). Recent global data on trends in the median CD4 count at diagnosis and ART initiation are not encouraging. We identify a critical need for new targets and metrics for persons newly diagnosed with HIV, newly enrolling in HIV care, and newly initiating ART, based on pre-treatment CD4 counts, to help increase the focus of implementation efforts on achieving earlier diagnosis, linkage to care, and ART initiation.
HIV 血清转换后早期诊断和治疗可改善个体和人群的健康状况。利用发表的治疗前 CD4 细胞计数数据，我们以成功降低 HIV 相关死亡率（INSIGHT/START）和 HIV 传播（HPTN 052）的标志性对照试验的治疗和对照组为基准，评估了“真实世界”中 HIV 诊断和 ART 启动时免疫缺陷的程度。
INSIGHT/START 试验和 HPTN 052 试验治疗组与对照组的 CD4 中位数分别为 650 与 408 个细胞/μL 和 442 与 221 个细胞/μL。在现实世界中，最近全球 ART 开始时 CD4 中位数的估计值范围为 234 至 350 个细胞/μL，只有 25%的人早期开始 ART（即 CD4>500 个细胞/μL）。最近全球关于诊断和 ART 启动时 CD4 中位数趋势的数据并不乐观。我们发现，迫切需要根据治疗前 CD4 计数，为新诊断出 HIV、新参加 HIV 护理和新开始接受 ART 的人群制定新的目标和指标，以帮助将实施工作的重点更多地放在早期诊断、护理联系和 ART 启动上。
