Denis Nash1,2,3, McKaylee Robertson4,5. 1. Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA. denis.nash@sph.cuny.edu. 2. Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA. denis.nash@sph.cuny.edu. 3. CUNY Institute for Implementation Science in Population Health, 55 W. 125th St., 6th Floor, New York, NY, USA. denis.nash@sph.cuny.edu. 4. Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA. 5. Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA.
Abstract
PURPOSE OF THE REVIEW: Early diagnosis and treatment of HIV following seroconversion improves individual and population health. Using published data on pre-treatment CD4 cell counts, we benchmarked the level of immunodeficiency at HIV diagnosis and ART initiation in the "real world" against those of the treatment and control arms of landmark controlled trials that successfully reduced HIV-related deaths (INSIGHT/START) and onward HIV transmission (HPTN 052). RECENT FINDINGS: The median CD4 count in the treatment vs. control arms of the INSIGHT/START trial and HPTN 052 were 650 vs. 408 cells/μL and 442 vs. 221 cells/μL, respectively. In the real world, recent global estimates of the median CD4 count at start of ART range from 234 to 350 cells/μL, and only 25% of those initiating ART do so early (i.e., with CD4 > 500 cells/μL). Recent global data on trends in the median CD4 count at diagnosis and ART initiation are not encouraging. We identify a critical need for new targets and metrics for persons newly diagnosed with HIV, newly enrolling in HIV care, and newly initiating ART, based on pre-treatment CD4 counts, to help increase the focus of implementation efforts on achieving earlier diagnosis, linkage to care, and ART initiation.
PURPOSE OF THE REVIEW: Early diagnosis and treatment of HIV following seroconversion improves individual and population health. Using published data on pre-treatment CD4 cell counts, we benchmarked the level of immunodeficiency at HIV diagnosis and ART initiation in the "real world" against those of the treatment and control arms of landmark controlled trials that successfully reduced HIV-related deaths (INSIGHT/START) and onward HIV transmission (HPTN 052). RECENT FINDINGS: The median CD4 count in the treatment vs. control arms of the INSIGHT/START trial and HPTN 052 were 650 vs. 408 cells/μL and 442 vs. 221 cells/μL, respectively. In the real world, recent global estimates of the median CD4 count at start of ART range from 234 to 350 cells/μL, and only 25% of those initiating ART do so early (i.e., with CD4 > 500 cells/μL). Recent global data on trends in the median CD4 count at diagnosis and ART initiation are not encouraging. We identify a critical need for new targets and metrics for persons newly diagnosed with HIV, newly enrolling in HIV care, and newly initiating ART, based on pre-treatment CD4 counts, to help increase the focus of implementation efforts on achieving earlier diagnosis, linkage to care, and ART initiation.
Authors: McKaylee M Robertson; Sarah L Braunstein; Donald R Hoover; Sheng Li; Denis Nash Journal: Clin Infect Dis Date: 2020-11-05 Impact factor: 9.079
Authors: Elizabeth Zaniewski; Ellen Brazier; Cam Ha Dao Ostinelli; Robin Wood; Meg Osler; Karl-Günter Technau; Joep J van Oosterhout; Nicola Maxwell; Janneke van Dijk; Hans Prozesky; Matthew P Fox; Jacob Bor; Denis Nash; Matthias Egger Journal: J Clin Epidemiol Date: 2021-09-03 Impact factor: 6.437
Authors: Amy C Justice; Matthew B Goetz; Cameron N Stewart; Brenna C Hogan; Elizabeth Humes; Paula M Luz; Jessica L Castilho; Denis Nash; Ellen Brazier; Beverly Musick; Constantin Yiannoutsos; Karen Malateste; Antoine Jaquet; Morna Cornell; Tinei Shamu; Reena Rajasuriar; Awachana Jiamsakul; Keri N Althoff Journal: Lancet HIV Date: 2022-02-23 Impact factor: 16.070
Authors: Katia Giguère; Jeffrey W Eaton; Kimberly Marsh; Leigh F Johnson; Cheryl C Johnson; Eboi Ehui; Andreas Jahn; Ian Wanyeki; Francisco Mbofana; Fidèle Bakiono; Mary Mahy; Mathieu Maheu-Giroux Journal: Lancet HIV Date: 2021-03-02 Impact factor: 12.767
Authors: Marie A Brault; Donna Spiegelman; James Hargreaves; Denis Nash; Sten H Vermund Journal: J Acquir Immune Defic Syndr Date: 2019-12-01 Impact factor: 3.731