CD4 lymphocyte count as an indicator of delay in seeking human immunodeficiency virus-related treatment
M. H. Katz, A. B. Bindman, D. Keane and A. K. Chan
Department of Public Health, University of California, San Francisco.
BACKGROUND--As many as half of patients infected with the human
immunodeficiency virus who are medically eligible for Pneumocystis
prophylaxis and zidovudine treatment have not received these treatments. We
used the CD4 lymphocyte count as an indicator of delay in seeking treatment
among patients infected with human immunodeficiency virus and assessed
whether insurance status was associated with the stage of illness when care
is initiated. METHODS--Data from 96 patients who initiated medical care at
a university acquired immunodeficiency syndrome clinic from August 1989 to
January 1991 were retrospectively reviewed. RESULTS--Patients initiated
care at a relatively late stage of illness (mean CD4 lymphocyte count, 0.37
x 10(9)/L [369/mm3]), and 29% were below the threshold for Pneumocystis
prophylaxis. Patients with private insurance had significantly lower CD4
counts (mean, 0.27 x 10(9)/L) than did individuals with public insurance
(mean, 0.46 x 10(9)/L). CD4 counts did not increase during the 18-month
study period. CONCLUSIONS--The majority of patients infected with human
immunodeficiency virus are eligible for medical therapy and could benefit
by initiating care sooner. Private insurance was not associated with
initiating early care, supporting anecdotal reports that some privately
insured individuals may be reluctant to seek care for a human
immunodeficiency virus-related condition.
