For people with HIV living in resource-rich nations, the average CD4 count upon entry into care has not seen an appreciable increase during the past two decades, aidsmap reports. As of 2011, that figure was 336. The finding has major implications for the current debate over the best timing for beginning antiretrovirals, implying that policies to start therapy at 500 CD4s rather than 350 lose their poignancy when so many HIV-positive people present themselves to care relatively late in the course of their infection.

Publishing their findings in Clinical Infectious Diseases, researchers from the United States and the United Kingdom conducted a systematic review of 44 studies, including data spanning from 1992 to 2011, on the CD4 counts when entering care of 169,000 people with HIV. The studies were largely from the United States and United Kingdom with a respective 18 and 11 between them.

In 1992, the average CD4 count upon entry into care was 307. By 2011, this figure rose to 336, for an increase of 1.5 cells each year. However, statistically, the CD4 level remained essentially unchanged, meaning any apparent differences could have been explained by chance. Furthermore, the proportion of those entering care late or very late reduced only slightly during the two-decade period, with a reduction of just 0.1 percent per year.

The authors wrote, “Our study findings indicate that the considerations of when to start [therapy] may be immaterial for the majority of patients who continue to enter care below any of the recommended treatment thresholds.”

In an accompanying editorial, Joep Lange, MD, a professor of medicine and head of the Department of Global Health at the Academic Medical Center at the University of Amsterdam in the Netherlands, wrote, “The finding that so little has changed with regard to time of presentation to HIV care in a period that saw dramatic improvements in HIV treatment and monitoring is astonishing.”

To read the aidsmap story, click here.

To read the study abstract, click here.

To read an editorial commentary about the study, published in CID, click here.