Journal Article

Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment — 10 Countries, 2004–2015

Tsui, Sharon, Zulu, Isaac, Sawadogo, Souleymane, Dalhatu, Ibrahim, Hachizovu, Sebastian, Denison, Julie, Ao, Trong, Ramadhani, Angela A., Swai, Patrick, Williams, Seymour G., Oboho, Ikwo, Namale, Alice, Mulenga, Modest, Lyss, Sheryl, Bingham, Trista, Kwesigabo, Gideon, Spira, Thomas, Agolory, Simon, Duval, Nirva, Mugisa, Bridget, Mackellar, Duncan, Auld, Andrew F., Chun, Helen, Ryan, Caroline, Nguyen, Duc B., Nuwagaba-Biribonwoha, Harriet, Desforges, Gracia, Robin, Ermane, Okello, Velephi, Tomlinson, Hank, Bicego, George, Antoine, Mayer, Mutandi, Gram, Lowrance, David, Mfaume, Mohamed, Gudo, Eduardo Samo, Ng’wangu, Kahemele, Hamilton, Carol, Odafe, Solomon, Adler, Michelle R., Ross, Christine, Alfredo, Charity, van Praag, Eric, Vergara, Alfredo, Debem, Henry H., Pathmanathan, Ishani, Couto, Aleny, Lloyd, Spencer, Swaminathan, Mahesh, Mugurungi, Owen, Francois, Kesner, Mastro, Timothy D., Abiri, Oseni Omomo, Kalamya, Julius N., Pelletier, Valerie, Delcher, Chris, Gongo, Ramadhani, Koole, Olivier, Onotu, Dennis, Ellerbrock, Tedd V., Colebunders, Robert, Gonese, Elizabeth, Dee, Jacob, Deyde, Varough, Bashorun, Ade

2017

Overview

Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.* To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended \"treat-all\" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence.

• Publisher: Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services,U.S. Center for Disease Control,Centers for Disease Control and Prevention
• Subject: Accounting / Acquired immune deficiency syndrome / Africa - epidemiology / AIDS / Anti-Retroviral Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / CD4 antigen / CD4 Lymphocyte Count - statistics & numerical data / Disease / Drug therapy / Electronic medical records / Enrollments / Full Report / Guidelines / Haiti - epidemiology / Health sciences / HIV / HIV Infections - drug therapy / HIV Infections - epidemiology / HIV Infections - immunology / Human immunodeficiency virus / Humans / Immune response / Lymphocytes T / Medical electronics / Medical records / Medical tests / Medical treatment / Monitoring / Patients / Prescription drugs / Prevalence / Prevention programs / Preventive medicine / Systems analysis / Therapy / Trends / Vietnam - epidemiology / Viruses