Prevalence of transmitted drug resistance also increased.
The average CD4 cell count at which young people living with HIV in New York City started antiretroviral therapy increased significantly after US guidelines changed in late 2009 to recommend therapy at higher counts, investigators report in the online edition of Clinical Infectious Diseases. The study also showed that 18% of young people had transmitted drug resistance, potentially limiting their choice of anti-HIV drugs.
“We found a significant increase in the mean CD4 count at initiation of ART [antiretroviral therapy] after…guidelines changed in December 2009,” comment the authors. “Our findings demonstrate uptake of the 2009 ART initiation guidelines.”
HIV treatment recommendations for young people (adolescents and young adults aged 13 to 24 years) follow those for adults. US antiretroviral treatment guidelines have been revised on several occasions in recent years, each time recommending the earlier initiation of therapy compared to previous editions of the guidelines. In December 2009, people with CD4 counts between 350 and 500 cells/mm3 became eligible for treatment. In early 2013, guidelines were again revised, this time recommending treatment for everyone with HIV, regardless of immune status.
But relatively little is known about the timing of antiretroviral treatment initiation in young people. There are also important knowledge gaps concerning the prevalence of transmitted drug resistance in this patient group, with estimates ranging between 5 and 18%.
Investigators therefore designed a retrospective study involving 331 young people newly presenting for HIV care in New York City between 2007 and 2011. Data were gathered on CD4 cell count and viral load on entry to care and at the time treatment was started. Results of baseline genotypic resistance tests were available for a subset of 212 patients. None of the participants had taken pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) and all were antiretroviral naive. All the patients acquired HIV via sexual contact or as a result of injecting drug use.