Case notes were available for 421 patients (90.1%). Of these patients, 253 of 421 (60.1%) had a previous CD4 count >200 cells/μL with a decrease in CD4 count to <200 cells/μL while under care (group A). The remainder [168 of 421 (39.9%)] had a CD4 count <200 cells/μL at the time of their first presentation, marking the start of the immunosuppressive episode under study (group B). The proportion of patients in group A was higher in centre 1 (68.4%) than in centre 2 (50.3%) (P<0.001). http://www.selleckchem.com/products/BIBW2992.html The median age of
the patients was 40 years [interquartile range (IQR) 34–45] (Table 1). The majority of patients were male (70.1%), and roughly half were heterosexual (49.6%) and were of black ethnicity (47.0%). Patients in group B (late presenters) were more likely to be of black ethnicity (P=0.003) and to be heterosexual than patients in group A (P<0.001). At centre 1, patients were more likely to be white UK-born and MSM compared with centre 2 (42.1%vs. 24.9% and 53.5%vs. 33.2%, respectively; both P<0.0001).
The median time from Ipilimumab purchase first presentation to most recent CD4 <200 cells/μL (t1–t3) was 39 months (IQR 13–86 months). The majority (178; 70.4%) were not receiving ART at the time at which the CD4 count first fell to <200 cells/μL in this immunosuppressive episode (Table 2). Patient-related factors accounted for 143 of 178 patients not receiving ART (75.8%). Patient-initiated TI was the most common explanation (58 of 178 patients; 32.6%). Documented reasons included difficulties with taking tablets and side effects (n=18), mental health issues (n=14), social and housing issues (n=5), ‘feeling well’ (n=4), travel out of the UK (n=4) and ‘other’/not stated (n=13). Other reasons included nonattendance at clinic for ≥6 months prior to the decrease in CD4 cell count (34 of 178 patients; 19.1%) and patients declining to FAD take ART (36 of 178 patients; 20.2%). Reasons for declining included fear of side effects (n=9), ‘feeling well’ (n=7), mental health issues (n=6), travel outside of the United Kingdom (n=5) and ‘other’ (n=7). The clinician did not offer treatment before the CD4 count decrease to <200 cells/μL
in 43 of 178 patients (24.1%). In 39 of 178 patients (21.9%), ART was not offered as there was no clinical indication at previous attendance (where patient attended within 6 months of the decrease in CD4 cell count). In these patients the median prior CD4 count was 270 cells/μL (IQR 245–375 cells/μL) a median of 12 weeks (IQR 8–12 weeks) before the CD4 count first fell to <200 cells/μL. The majority of patients [135 of 178 patients (75.8%)] were subsequently started on ART a median of 7 weeks (IQR 3–10.5 weeks) after the CD4 count first fell to <200 cells/μL (t2). Of the remaining 43 patients, 26 declined the offer of ART. Documented reasons included fear of side effects (n=9), ‘feeling well’ (n=7), mental health issues (n=6) and travel outside of the United Kingdom (n=4).