Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

HIV Med. 2008 Jul;9(6):397-405. doi: 10.1111/j.1468-1293.2008.00566.x. Epub 2008 Apr 10.


Objectives: To investigate delayed HIV diagnosis and late initiation of antiretroviral therapy (ART) in the Swiss HIV Cohort Study.

Methods: Two sub-populations were included: 1915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration (group A), and 1730 treatment-naïve patients with CD4>or=200 cells/microL before their second cohort visit (group B). In group A, predictors for low initial CD4 cell counts were examined with a median regression. In group B, we studied predictors for CD4<200 cells/microL without ART despite cohort follow-up.

Results: Median initial CD4 cell count in group A was 331 cells/microL; 31% and 10% were <200 and <50 cells/microL, respectively. Risk factors for low CD4 count were age and non-White race. Homosexual transmission, intravenous drug use and living alone were protective. In group B, 30% initiated ART with CD4>or=200 cells/microL; 18% and 2% dropped to CD4 <200 and <50 cells/microL without ART, respectively. Sub-Saharan origin was associated with lower probability of CD4 <200 cells/microL without ART during follow-up. Median CD4 count at ART initiation was 207 and 253 cells/microL in groups A and B, respectively.

Conclusions: CD4<200 cells/microL and, particularly, CD4<50 cells/microL before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / prevention & control*
  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • CD4 Lymphocyte Count / standards
  • Disease Progression
  • Drug Administration Schedule
  • Early Diagnosis
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV-1*
  • Humans
  • Male
  • RNA, Viral / analysis
  • Risk Factors
  • Viral Load


  • Anti-Retroviral Agents
  • RNA, Viral