Progress, but Remaining Disparities, in ART Initiation and Viral Suppression Equality

The U.S. Department of Health and Human Services issued guidelines recommending antiretroviral therapy (ART) initiation for HIV infection at a CD4 threshold of 350 cells/mm³ in December 2007, then increased the threshold to 500 cells/mm³ in December 2009 and to treatment regardless of threshold in February 2013. To assess the effect of these changes, investigators analyzed time from presentation for HIV care to ART initiation and viral suppression among 15,272 patients who entered care between 2003 and 2012.

Median CD4 count at enrollment increased from 273.5 cells/mm³ in 2003–2004 to 332 cells/mm³ in 2011–2012; median CD4 count at ART initiation increased from 201 to 285 cells/mm³. The percentage of patients presenting with CD4 count <200 c…