Factors associated with immune status in the diagnosis of HIV infection

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IntroductionCurrent guidelines recommend the start of antiretroviral therapy before advanced immunosuppression, which is not always possible. The purpose of this study is to evaluate factors associated with the degree of immunosuppression at the diagnosis of HIV infection.MethodsWe evaluated demographic and epidemiological data of HIV‐infected patients observed at the Department of Infectious Diseases diagnosed between 2006–2011, and analyzed the relationship between these data and the immune status at diagnosis. Statistical analysis was performed using SPSS version 20.0 for Windows.ResultsData from 600 new patients were analyzed. 584 (97.3%) infected by HIV‐1. 426 (71%) male. Mean age=42 years (SD=14). Risk factor for HIV infection: sexual in 548 patients (91.3%) (22.8% homo/bisexual). 153 (25.5%) patients had AIDS ‐defining illness. Origin of patients: general practitioner ‐ 153 (25.5%), hospitalization in the Department of Infectious Diseases ‐ 110 (18.3%), diagnostic screening after partner's diagnosis ‐ 69 (11.5%), hospital consultation ‐ 68 (11 3%), emergency room ‐ 61 (10.2%), anonymous diagnostic testing center ‐ 46 (7.7%), other hospital inpatient services ‐ 31 (5.2%), hospitalization in another hospital ‐ 30 (5%), attempted blood donation ‐ 15 (2.5%), drug addiction treatment center ‐ 8 (1.3%), pregnancy screening ‐ 3 (0.5%) and patient's own initiative ‐ 6 (1%). The mean CD4+ cell count was 319 cells/cmm (SD=274; range: 2–1416). Women were diagnosed at significantly higher CD4+ cell count levels (p=0.005), as well as younger patients (p<0.001). Homo/bisexual patients had CD4+ cell counts significantly higher than the other groups (p<0.001). There were differences in CD4+ cell count depending on the origin of the patients (p<0.001): patients diagnosed at anonymous diagnostic center, drug addiction treatment center, blood donors, pregnant women and coming on their own initiative, had higher CD4+ cell count levels (p<0.001). Patients admitted in the Department of Infectious Diseases were those with the lower CD4+ cell counts. No relationship was found between CD4+ cell count level and year of diagnosis.ConclusionThese results indicate the importance of early HIV screening even in individuals without a perceived risk of acquisition of this infection, so they can benefit from antiretroviral treatment before having advanced immunosuppression.