0
July 10, 1991, Vol 266, No. 2 >
ARTICLE | July 10, 1991

CD4 Lymphocyte Concentrations in Patients With Newly Identified HIV Infection Attending STD Clinics: Title and subTitle BreakPotential Impact on Publicly Funded Health Care Resources FREE

Catherine M. Hutchinson, BM,BS; Cara Wilson, MD; Cindy A. Reichart, MT(ASCP); Vincent C. Marsiglia, MT(ASCP), MHA; Jonathan M. Zenilman, MD; Edward W. Hook, III, MD
[+] Author Affiliations

Reprint requests to The Johns Hopkins Hospital, Infectious Diseases—Blalock 1111, 600 N Wolfe St, Baltimore, MD 21205 (Dr Hook).


JAMA. 1991;266(2):253-256. doi:10.1001/jama.1991.03470020079036
Text Size: A A A
Published online
Article
References

Since January 1990, human immunodeficiency virus (HIV)-infected patients attending two sexually transmitted disease clinics in Baltimore, Md, have been offered T-lymphocyte subset evaluations. From January through September, CD4+ lymphocyte concentrations were measured in 223 newly diagnosed HIV-infected patients; 50% had fewer than 500 CD4+ T cells and 12% had fewer than 200 CD4+ T cells per cubic millimeter. Most patients were asymptomatic, and, even among patients with fewer than 200 CD4+ T cells, 54% had no symptoms or signs suggestive of advanced HIV infection. Homosexually active men had significantly lower mean CD4+ lymphocyte concentrations than intravenous drug users. Given the substantial numbers of patients with CD4+ concentrations that qualified them for zidovudine therapy, we also assessed their mechanisms of paying for health care. Only 24% of HIV-infected patients had private insurance. Seventy-two percent of patients with fewer than 200 CD4+ T cells either had no insurance or relied on public assistance for health care. Thus, although 50% of asymptomatic individuals identified by routine voluntary HIV screening in an inner-city sexually transmitted disease clinic may benefit from therapy for their disease, 75% of those qualifying for presently recommended therapy either depend on publicly funded health care or have no means of payment for care.

(JAMA. 1991;266:253-256)

REFERENCES

1 +
Centers for Disease Control.  Publicly funded HIV counseling and testing—United States, 1985-1989. MMWR . 1990;;39:137-141.
2 +
Erickson B, Wasserheit JN, Rompalo AM, Brathwaite W, Glasser D, Hook EW III.  Routine voluntary HIV screening in STD clinic clients: characterization of infected clients. Sex Transm Dis . 1990;;17:194-199.
3 +
Gottlieb MS, Schroff R, Schanker HM, et al.  Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men. N Engl J Med . 1981;;305:1425-1431.
4 +
Rogers MF, Morens DM, Stewart JA, et al.  National case-control study of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men, part 2: laboratory results. Ann Intern Med . 1983;;99:151-158.
5 +
Goedert JJ, Biggar RJ, Winn DM, et al.  Determinants of retrovirus (HTLV-III) antibody and immunodeficiency conditions in homosexual men. Lancet . 1984;;2:711-715.
6 +
Goedert JJ, Biggar RJ, Melbye M, et al.  Effect of T4 count and cofactors on the incidence of AIDS in homosexual men infected with human immunodeficiency virus. JAMA . 1987;;257:331-334.
7 +
Stevens CE, Taylor PE, Zang EA, et al.  Human T-cell lymphotropic virus type III infection in a cohort of homosexual men in New York City. JAMA . 1986;;255:2167-2172.
8 +
Polk BF, Fox R, Brookmeyer R, et al.  Predictors of the acquired immunodeficiency syndrome developing in a cohort of seropositive homosexual men. N Engl J Med . 1987;;316:61-66.
9 +
Moss AR, Bacchetti P, Osmond D, et al.  Seropositivity for HIV and the development of AIDS or AIDS-related condition: three-year follow-up of the San Francisco General Hospital cohort. BMJ . 1988;;296:745-750.
10 +
Eyster ME, Ballard JO, Gail MH, Drummond JE, Goedert JJ.  Predictive markers for the acquired immunodeficiency syndrome (AIDS) in hemophiliacs: persistence of p24 antigen and low T4 cell count. Ann Intern Med . 1989;;110:963-969.
11 +
Giorgi JV, Detels R.  T-cell subset alterations in HIV-infected homosexual men: NIAID multicenter AIDS cohort study. Clin Immunol Immunopathol . 1989;;52:10-18.
12 +
Volberding PA, Lagakos SW, Koch MA, et al.  Zidovudine in asymptomatic human immunodeficiency virus infection. N Engl J Med . 1990;;322:941-949.
13 +
 State-of-the-art conference on azidothymidine therapy for early HIV infection. Am J Med . 1990;;89:335-344. NIH State-of-the-Art Conference.
14 +
Centers for Disease Control.  Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. MMWR . 1989;;381:1-9.
15 +
Masur H, Ognibene FP, Yarchoan, et al.  CD4 count as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection. Ann Intern Med . 1989;;111:223-231.
16 +
Redfield RR, Wright DC, Tramont EC.  The Walter Reed staging classification for HTLV-III/ LAV infection. N Engl J Med . 1986;;14:131-132.
17 +
Centers for Disease Control.  Screening for tuberculosis and tuberculous infection in high-risk populations: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR . 1990;;39:1-7.
18 +
Quinn TC, Cannon RO, Glasser D, et al.  The association of syphilis with risk of human immunodeficiency infection in patients attending sexually transmitted disease clinics. Arch Intern Med . 1990;;150:1297-1302.
19 +
Quinn TC, Glasser D, Cannon RO, et al.  Human immunodeficiency virus infection among patients attending clinics for sexually transmitted diseases. N Engl J Med . 1988;;318:197-203.
20 +
Centers for Disease Control.  The use of preventive therapy for tuberculous infection in the United States: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR . 1990;;39:9-12.
21 +
Lo B, Steinbrook RL, Cooke M, Coates TJ, Walters EJ, Hulley SB.  Voluntary screening for human immunodeficiency virus (HIV) infection. Ann Intern Med . 1989;;110:727-733.
22 +
Jacobsen PB, Perry SW, Hirch DA.  Behavioral and psychological responses to HIV antibody testing. J Consult Clin Psychol . 1990;;58:31-37.
23 +
Cates W, Handsfield HH.  HIV counseling and testing: does it work? Am J Public Health . 1988;;78:1533-1534.
24 +
Fox R, Odaka N, Brookmeyer R, Polk BF.  Effects of HIV antibody disclosure on subsequent sexual activity in homosexual men. AIDS . 1987;;1:241-246.
25 +
Van Griensven GJP, De Vroome EMM, Tielmman RAP, et al.  Impact of HIV antibody testing on changes in sexual behavior among homosexual men in the Netherlands. Am J Public Health . 1988;;78:1575-1577.
26 +
Coates TJ, Stall RD, Catania JA, Kegeles SM.  Behavioral factors in the spread of HIV infection. AIDS . 1988;;2:239-246.
27 +
McCusker J, Stoddard AM, Mayer KH, et al.  Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men. Am J Public Health . 1988;;78:462-467.
28 +
Schecther MT, Craib KJP, Willoughby B, et al.  Patterns of sexual behavior and condom use in a cohort of homosexual men. Am J Public Health . 1988;;78:1535-1538.
29 +
Zenilman JM, Erickson B, Fox R, Reichart CA, Hook EW III. Incidence of sexually transmitted disease in a population previously diagnosed with HIV-1 and post-test counseled. Presented at the 30th Interstate Conference on Antimicrobial Agents and Chemotherapy; October 23, 1990; Atlanta, Ga.
30 +
Friedland GH.  Early treatment for HIV: the time has come. N Engl J Med . 1990;;323:1000-1002.
31 +
Scitovsky AA, Rice DP.  Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991. Public Health Rep . 1987;;102:5-17.
32 +
Buchanan RJ.  State Medicaid coverage of AZT and AIDS-related policies. Am J Public Health . 1988;;78:462-467.
33 +
Scitovsky AA, Cline MW, Abrams DI.  Effects of the use of AZT on the medical care costs of persons with AIDS in the first 12 months. J Acquir Immune Defic Syndr . 1990;;3:904-912.
34 +
Arno PS, Shenson D, Siegel NF, Franks P, Lee PR.  Economic and policy implications of early intervention in HIV disease. JAMA . 1989;;262-1493-1498.
35 +
Cheung TW, Sacks HS.  The costs of HIV infections. JAMA . 1990;;263:1067-1068.
36 +
Drotman DP.  Earlier diagnosis of human immunodeficiency virus (HIV) infection and more counseling. Ann Intern Med . 1989;;110:680-681.
37 +
Ho DD, Moudgil T, Alam M.  Quantitation of human immunodeficiency virus type 1 in the blood of infected persons. N Engl J Med . 1989;;321:1621-1625.
38 +
Rango NA, Rampolla M.  Expanding the focus of human immunodeficiency virus prevention in the 1990's. N Y State J Med . 1990;;90:116-119.
39 +
Holmes KK, Karon JM, Kreiss J.  The increasing frequency of heterosexually acquired AIDS in the United States, 1983-88. Am J Public Health . 1990;;80:858-863.
40 +
Green J, Arno PS.  The 'Medicaidization' of AIDS: trends in the financing of HIV-related medical care. JAMA . 1990;;264:1261-1266.
41 +
Makadon HJ, Seage GR, Thorpe KE, Fineberg HV.  Paying the medical cost of the HIV epidemic: a review of policy options. J Acquir Immune Defic Syndr . 1990;;3:123-133.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Centers for Disease Control.  Publicly funded HIV counseling and testing—United States, 1985-1989. MMWR . 1990;;39:137-141.
2 +
Erickson B, Wasserheit JN, Rompalo AM, Brathwaite W, Glasser D, Hook EW III.  Routine voluntary HIV screening in STD clinic clients: characterization of infected clients. Sex Transm Dis . 1990;;17:194-199.
3 +
Gottlieb MS, Schroff R, Schanker HM, et al.  Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men. N Engl J Med . 1981;;305:1425-1431.
4 +
Rogers MF, Morens DM, Stewart JA, et al.  National case-control study of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men, part 2: laboratory results. Ann Intern Med . 1983;;99:151-158.
5 +
Goedert JJ, Biggar RJ, Winn DM, et al.  Determinants of retrovirus (HTLV-III) antibody and immunodeficiency conditions in homosexual men. Lancet . 1984;;2:711-715.
6 +
Goedert JJ, Biggar RJ, Melbye M, et al.  Effect of T4 count and cofactors on the incidence of AIDS in homosexual men infected with human immunodeficiency virus. JAMA . 1987;;257:331-334.
7 +
Stevens CE, Taylor PE, Zang EA, et al.  Human T-cell lymphotropic virus type III infection in a cohort of homosexual men in New York City. JAMA . 1986;;255:2167-2172.
8 +
Polk BF, Fox R, Brookmeyer R, et al.  Predictors of the acquired immunodeficiency syndrome developing in a cohort of seropositive homosexual men. N Engl J Med . 1987;;316:61-66.
9 +
Moss AR, Bacchetti P, Osmond D, et al.  Seropositivity for HIV and the development of AIDS or AIDS-related condition: three-year follow-up of the San Francisco General Hospital cohort. BMJ . 1988;;296:745-750.
10 +
Eyster ME, Ballard JO, Gail MH, Drummond JE, Goedert JJ.  Predictive markers for the acquired immunodeficiency syndrome (AIDS) in hemophiliacs: persistence of p24 antigen and low T4 cell count. Ann Intern Med . 1989;;110:963-969.
11 +
Giorgi JV, Detels R.  T-cell subset alterations in HIV-infected homosexual men: NIAID multicenter AIDS cohort study. Clin Immunol Immunopathol . 1989;;52:10-18.
12 +
Volberding PA, Lagakos SW, Koch MA, et al.  Zidovudine in asymptomatic human immunodeficiency virus infection. N Engl J Med . 1990;;322:941-949.
13 +
 State-of-the-art conference on azidothymidine therapy for early HIV infection. Am J Med . 1990;;89:335-344. NIH State-of-the-Art Conference.
14 +
Centers for Disease Control.  Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. MMWR . 1989;;381:1-9.
15 +
Masur H, Ognibene FP, Yarchoan, et al.  CD4 count as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection. Ann Intern Med . 1989;;111:223-231.
16 +
Redfield RR, Wright DC, Tramont EC.  The Walter Reed staging classification for HTLV-III/ LAV infection. N Engl J Med . 1986;;14:131-132.
17 +
Centers for Disease Control.  Screening for tuberculosis and tuberculous infection in high-risk populations: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR . 1990;;39:1-7.
18 +
Quinn TC, Cannon RO, Glasser D, et al.  The association of syphilis with risk of human immunodeficiency infection in patients attending sexually transmitted disease clinics. Arch Intern Med . 1990;;150:1297-1302.
19 +
Quinn TC, Glasser D, Cannon RO, et al.  Human immunodeficiency virus infection among patients attending clinics for sexually transmitted diseases. N Engl J Med . 1988;;318:197-203.
20 +
Centers for Disease Control.  The use of preventive therapy for tuberculous infection in the United States: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR . 1990;;39:9-12.
21 +
Lo B, Steinbrook RL, Cooke M, Coates TJ, Walters EJ, Hulley SB.  Voluntary screening for human immunodeficiency virus (HIV) infection. Ann Intern Med . 1989;;110:727-733.
22 +
Jacobsen PB, Perry SW, Hirch DA.  Behavioral and psychological responses to HIV antibody testing. J Consult Clin Psychol . 1990;;58:31-37.
23 +
Cates W, Handsfield HH.  HIV counseling and testing: does it work? Am J Public Health . 1988;;78:1533-1534.
24 +
Fox R, Odaka N, Brookmeyer R, Polk BF.  Effects of HIV antibody disclosure on subsequent sexual activity in homosexual men. AIDS . 1987;;1:241-246.
25 +
Van Griensven GJP, De Vroome EMM, Tielmman RAP, et al.  Impact of HIV antibody testing on changes in sexual behavior among homosexual men in the Netherlands. Am J Public Health . 1988;;78:1575-1577.
26 +
Coates TJ, Stall RD, Catania JA, Kegeles SM.  Behavioral factors in the spread of HIV infection. AIDS . 1988;;2:239-246.
27 +
McCusker J, Stoddard AM, Mayer KH, et al.  Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men. Am J Public Health . 1988;;78:462-467.
28 +
Schecther MT, Craib KJP, Willoughby B, et al.  Patterns of sexual behavior and condom use in a cohort of homosexual men. Am J Public Health . 1988;;78:1535-1538.
29 +
Zenilman JM, Erickson B, Fox R, Reichart CA, Hook EW III. Incidence of sexually transmitted disease in a population previously diagnosed with HIV-1 and post-test counseled. Presented at the 30th Interstate Conference on Antimicrobial Agents and Chemotherapy; October 23, 1990; Atlanta, Ga.
30 +
Friedland GH.  Early treatment for HIV: the time has come. N Engl J Med . 1990;;323:1000-1002.
31 +
Scitovsky AA, Rice DP.  Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991. Public Health Rep . 1987;;102:5-17.
32 +
Buchanan RJ.  State Medicaid coverage of AZT and AIDS-related policies. Am J Public Health . 1988;;78:462-467.
33 +
Scitovsky AA, Cline MW, Abrams DI.  Effects of the use of AZT on the medical care costs of persons with AIDS in the first 12 months. J Acquir Immune Defic Syndr . 1990;;3:904-912.
34 +
Arno PS, Shenson D, Siegel NF, Franks P, Lee PR.  Economic and policy implications of early intervention in HIV disease. JAMA . 1989;;262-1493-1498.
35 +
Cheung TW, Sacks HS.  The costs of HIV infections. JAMA . 1990;;263:1067-1068.
36 +
Drotman DP.  Earlier diagnosis of human immunodeficiency virus (HIV) infection and more counseling. Ann Intern Med . 1989;;110:680-681.
37 +
Ho DD, Moudgil T, Alam M.  Quantitation of human immunodeficiency virus type 1 in the blood of infected persons. N Engl J Med . 1989;;321:1621-1625.
38 +
Rango NA, Rampolla M.  Expanding the focus of human immunodeficiency virus prevention in the 1990's. N Y State J Med . 1990;;90:116-119.
39 +
Holmes KK, Karon JM, Kreiss J.  The increasing frequency of heterosexually acquired AIDS in the United States, 1983-88. Am J Public Health . 1990;;80:858-863.
40 +
Green J, Arno PS.  The 'Medicaidization' of AIDS: trends in the financing of HIV-related medical care. JAMA . 1990;;264:1261-1266.
41 +
Makadon HJ, Seage GR, Thorpe KE, Fineberg HV.  Paying the medical cost of the HIV epidemic: a review of policy options. J Acquir Immune Defic Syndr . 1990;;3:123-133.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems