부산대학교 도서관

Objectives Current British HIV Association ( BHIVA) guidelines recommend that all patients with a CD4 count <350 cells/μ L are offered highly active antiretroviral therapy ( HAART). We identified risk factors for delayed initiation of HAART following a CD4 count <350 cells/μ L. Methods All adults under follow-up in 2008 who had a first confirmed CD4 count <350 cells/μ L from 2004 to 2008, who had not initiated treatment and who had >6 months of follow-up were included in the study. Characteristics at the time of the low CD4 cell count and over follow-up were compared to identify factors associated with delayed HAART uptake. Analyses used proportional hazards regression with fixed (sex/risk group, age, ethnicity, AIDS, baseline CD4 cell count and calendar year) and time-updated (frequency of CD4 cell count measurement, proportion of CD4 counts <350 cells/μ L, latest CD4 cell count, CD4 percentage and viral load) covariates. Results Of 4871 patients with a confirmed low CD4 cell count, 436 (8.9%) remained untreated. In multivariable analyses, those starting HAART were older [adjusted relative hazard ( aRH)/10 years 1.15], were more likely to be female heterosexual ( aRH 1.13), were more likely to have had AIDS ( aRH 1.14), had a greater number of CD4 measurements < 350 cells/μ L ( aRH/additional count 1.18), had a lower CD4 count over follow-up ( aRH/50 cells/μ L higher 0.57), had a lower CD4 percentage ( aRH/5% higher 0.90) and had a higher viral load ( aRH/log10 HIV-1 RNA copies/ml higher 1.06). Injecting drug users ( aRH 0.53), women infected with HIV via nonsexual or injecting drug use routes ( aRH 0.75) and those of unknown ethnicity ( aRH 0.69) were less likely to commence HAART. Conclusion A substantial minority of patients with a CD4 count < 350 cells/μ L remain untreated despite its indication. [ABSTRACT FROM AUTHOR]