摘要：Objectives . We used statewide data to assess HIV disease stage at initial diagnosis and laboratory indications for initiating antiretroviral therapy among South Carolina residents with newly diagnosed HIV infection. Methods . Initial CD4+ counts and viral loads among individuals diagnosed with HIV between May 2004 and April 2005 were categorized according to current staging and treatment guidelines. Results . Of 759 individuals who had a CD4+ count reported, 34% and 56% had counts of 200 cells/mm3 or below and 350 cells/mm3 or below, respectively. CD4+ counts of 200 cells/mm3 or below were significantly associated with male gender (adjusted odds ratio [AOR] = 2.07; 95% confidence interval [CI] = 1.36, 3.16), age above 29 years (AOR = 2.45; 95% CI = 1.51, 3.96), and hospital-reported patients (AOR = 2.17; 95% CI = 1.41, 3.36). The same characteristics were significant risk factors for elevated viral loads. Conclusions . At least in South Carolina, HIV diagnoses are delayed in a significant percentage of patients. New testing strategies need to be implemented to encourage earlier HIV diagnoses, and future studies should evaluate the effects of expanded routine testing on earlier detection. Approximately 800 people are newly diagnosed with HIV infection in South Carolina every year. 1 For the past several years, the state has consistently ranked among the top 10 in terms of annual AIDS case rates in the United States. For example, in 2004, South Carolina was ranked 26th among the 50 states and the District of Columbia in overall population but 10th in number of AIDS cases per 100 000 population. 2 In combination with a patient's clinical state, CD4+ T-cell counts and HIV-1 RNA levels are used in determining disease stage and initiation of therapy. CD4+ T-cell counts are used in laboratory staging of HIV (levels below 200 cells/mm3 are classified as laboratory AIDS), and both CD4+ counts (below 350 cells/mm3) and HIV-1 RNA levels (above 100 000 copies/mL) are used to determine need for commencement of antiretroviral therapy. Anecdotal evidence suggests that many HIV-infected patients are diagnosed at an advanced disease stage. Several studies have demonstrated that patients who initiate highly active antiretroviral therapy (HAART) with CD4+ T-cell counts above 200 cells/mm3, HIV-1 RNA levels below 50 000 copies/mL, and no clinical AIDS-defining events are less likely to experience adverse clinical outcomes. 3 – 5 By contrast, individuals who begin HAART when their CD4+ T-cell counts are below 200 cells/mm3 do not respond as well to therapy and have worse prognoses than those who initiate therapy at higher CD4+ T-cell counts. 6 The lack of complete reporting of HIV laboratory markers (CD4+ T-cell counts and HIV-1 RNA levels) in many states has not allowed for quantification of disease stage at initial diagnosis. Only a few small studies have been able to link newly diagnosed cases to laboratory markers of immune deficiency and stage of HIV disease. Capitalizing on the unique opportunity provided by the robust and complete electronic HIV/AIDS reporting system in South Carolina, we used initial CD4+ T-cell counts and plasma viral RNA (viral loads) to characterize newly diagnosed HIV patients at the statewide (population) level.
