Trends in baseline CD4 count at presentation to care among HIV-positive patients in Sungai Buloh Hospital, Malaysia

Introduction
Many people living with human immunodeficiency virus (HIV) do not enter healthcare until late in their infection course. We analysed the trends in baseline CD4 count among HIV patients in Sungai Buloh Hospital, Malaysia.

Material and methods
A retrospective cohort study was conducted from the Malaysian AIDS Treatment Cohort (MATCH) database of HIV-positive patients registered in our HIV clinic between 2007 and 2016.

Results
Out of 8757 patients, 84.5% were male. Heterosexual (38.2%) and homosexual (36.4%) contacts were the predominant HIV risk factors. Approximately 44% of patients presented late to care (CD4 < 200 cells/µl). The overall median baseline CD4 cell count was 235 cells/µl. The yearly median baseline CD4 cell count increased steadily from 176 cells/µl in 1997 to a peak of 271 cells/µl in 2015 (p for trend < 0.001). By HIV exposure risks, homosexual risk group consistently had the highest median baseline CD4 cell count, followed by heterosexual and intravenous drug use (IVDU) risk groups. The proportion of late presenters significantly decreased over time from 57.0% in 2007 to 44.0% in 2016 (p for trend < 0.001).

Conclusions
The trends in baseline CD4 cell counts are improving, but the proportion of late presenters is still significant. Innovative strategies are imperative to identify HIV infected individuals early and link them promptly to HIV care.