Declines in highly active antiretroviral therapy initiation at CD4 cell counts ≤ 200 cells/μL and the contribution of diagnosis of HIV at CD4 cell counts ≤ 200 cells/μL in British Columbia, Canada.

ObjectivesThe aim of the study was to examine trends in initiating highly active antiretroviral therapy (HAART) with a CD4 count 200cells/L and the contribution of having a CD4 count 200cells/L at the time of diagnosis to these trends, in British Columbia (BC), Canada. MethodsWe included in the analysis treatment-naive BC residents aged 19 years who initiated HAART from 2003 to 2012. Participants were classified as follows: Group 1: diagnosed and initiated HAART with a CD4 count >200cells/L; Group 2: diagnosed with a CD4 count >200cells/L and initiated HAART with a CD4 count 200cells/L; and Group 3: diagnosed and initiated HAART with a CD4 count 200cells/L. We measured trends in initiating HAART with a CD4 count 200cells/L and used logistic regression models to measure factors associated with initiating HAART with a CD4 count 200cells/L, stratified by having a CD4 count 200cells/L or >200cells/L at the time of diagnosis. ResultsBetween 2003 and 2012, 3506 BC residents initiated HAART. Of these, 44% (1558 of 3506) initiated HAART with a CD4 count 200cells/L. This proportion declined from 69% (198 of 287) in 2003 to 21% (81 of 330) in 2012 (P<0.001). The proportion of those in Group 3 increased from 49% (97 of 198) in 2003 to 69% (56 of 81) in 2012 (P<0.001). Overall, 56% (1948), 22% (776) and 22% (782) made up Groups 1, 2, and 3, respectively. In adjusted analyses, seeing a specialist was significantly associated with being in Group 3. Using injection drugs and seeing a specialist were associated with being in Group 2. ConclusionsIn recent years, among individuals who ever initiated HAART in BC, being diagnosed with low CD4 cell counts has become a greater contributor to initiating HAART with low CD4 cell counts.