Proportions of CD4 test results indicating advanced HIV disease remain consistently high at primary health care facilities across four high HIV burden countries

Autoři: Katherine Lamp aff001;  Seth McGovern aff001;  Youyi Fong aff002;  Charles Diko Atem aff003;  Jean Bosco Elat Nfetam aff004;  Divine Nzuobontane aff003;  Timothy Bollinger aff005;  Ilesh Jani aff006;  Nadia Sitoe aff006;  Charles Kiyaga aff007;  George Senyama aff008;  Phibeon M. Mangwendeza aff009;  Sekesai Mtapuri-Zinyowera aff010;  Naoko Doi aff001;  Trevor Peter aff001;  Jilian A. Sacks aff001;  Lara Vojnov aff001
Působiště autorů: Clinton Health Access Initiative, Boston, MA, United States of America aff001;  Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America aff002;  Clinton Health Access Initiative, Yaoundé, Cameroon aff003;  National AIDS Control Committee, Yaoundé, Cameroon aff004;  Clinton Health Access Initiative, Maputo, Mozambique aff005;  Instituto Nacional de Saúde, Maputo, Mozambique aff006;  Central Public Health Laboratory, Kampala, Uganda aff007;  Clinton Health Access Initiative, Kampala, Uganda aff008;  Clinton Health Access Initiative, Harare, Zimbabwe aff009;  Ministry of Health and Child Care, Harare, Zimbabwe aff010
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



Globally, nearly 22 million HIV-infected patients are currently accessing antiretroviral treatment; however, almost one million people living with HIV died of AIDS-related illnesses in 2018. Advanced HIV disease remains a significant issue to curb HIV-related mortality.


We analyzed 864,389 CD4 testing records collected by 1,016 Alere Pima Analyzers implemented at a variety of facilities, including peripheral facilities, between January 2012 and December 2016 across four countries in sub-Saharan Africa. Routinely collected data and programmatic records were used to analyze the median CD4 counts and proportions of patients with advanced HIV disease by country, facility type, and year.


Median CD4 counts were between 409–444 cells/ul each year since 2012 with a median in 2016 of 444 cells/ul (n = 319,829). The proportion of test results returning CD4 counts above 500 cells/ul has increased slowly each year with 41.8% (95% CI: 41.6–41.9%) of tests having a CD4 count above 500 cells/ul in 2016. Median CD4 counts were similar across facility types. The proportion of test results indicating advanced HIV disease has remained fairly consistent: 19.4% (95% CI: 18.8–20.1%) in 2012 compared to 16.1% (95% CI: 16.0–16.3%) in 2016. The proportion of test results indicating advanced HIV disease annually ranged from 14.5% in Uganda to 29.8% in Cameroon. 6.9% (95% CI: 6.8–7.0%) of test results showed very advanced HIV disease (CD4<100 cells/ul) in 2016.


The proportion of CD4 test results indicating advanced disease was relatively high and consistent across four high HIV burden countries.

Klíčová slova:

Cameroon – Health care facilities – HIV – HIV diagnosis and management – Morbidity – Mozambique – Viral load – Zimbabwe


1. World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. Geneva, Switzerland. 2010.

2. World Health Organization. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva, Switzerland. 2013.

3. World Health Organization. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva, Switzerland. 2016.

4. Doherty M, Beusemberg M, Vitoria M, Ford N, Low Beer D, Hirnschall G. Treat All: WHO policy adoption and implementation status in countries. 22nd International AIDS Conference. 2018. Amsterdam, Netherlands. Abstract THPED563.

5. Clinton Health Access Initiative. 2018 HIV Market Report. Accessed January 25, 2019:

6. World Health Organization. Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. Geneva, Switzerland. 2017.

7. World Health Organization. What’s new in treatment monitoring: viral load and CD4 testing. Geneva, Switzerland. 2017.

8. Hakim J, Musiime V, Szubert AJ, Mallewa J, Siika A, Agutu C, et al. Enhanced prophylaxis plus antiretroviral therapy for advanced HIV infection in Africa. N Engl J Med. 2017;377:233–45. doi: 10.1056/NEJMoa1615822 28723333

9. Joint United National Programme on HIV/AIDS. Global AIDS Update: Miles to go, closing gaps, breaking barriers, righting injustices. Geneva. 2018.

10. Walker AS, Prendergast AJ, Mugyenyi P, Munderi P, Hakim J, Kekitiinwa A, et al. Mortality in the year following antiretroviral therapy initiation in HIV-infected adults and children in Uganda and Zimbabwe. Clin Infect Dis. 2012;55:1707–18. doi: 10.1093/cid/cis797 22972859

11. Ford N, Shubber Z, Meintjes G, Grinsztejn B, Eholie S, Mills EJ, et al. Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis. Lancet HIV. 2015;2:e438–44. doi: 10.1016/S2352-3018(15)00137-X 26423651

12. Low A, Gavriilidis G, Larke N, B-Lajoie MR, Drouin O, Stover J, et al. Incidence of opportunistic infections and the impact of antiretroviral therapy among HIV-infected adults in low- and middle-income countries: a systematic review and meta-analysis. Clin Infect Dis. 2016;62:1595–603. doi: 10.1093/cid/ciw125 26951573

13. Ford N, Meintjes G, Calmy A, Bygrave H, Migone C, Vitoria M, et al. Managing advanced HIV disease in a public health approach. Clin Infect Dis. 2018;66(S2):S106–110.

14. Post FA, Szubert AJ, Prendergast AJ, Johnston V, Lyall H, Fitzgerald F, et al. Causes and timing of mortality and morbidity among late presenters starting antiretroviral therapy in the REALITY trial. Clin Infect Dis. 2018;66(S2):S132–139.

15. Calmy A, Ford N, Meintjes G. The persistent challenge of advanced HIV disease and AIDS in the era of antiretroviral therapy. Clin Infect Dis. 2018;66(S2):S103–105.

16. Habiyambere V, Ford N, Low-Beer D, Nkengasong J, Sands A, Pérez González M, et al. Availability and Use of HIV Monitoring and Early Infant Diagnosis Technologies in WHO Member States in 2011–2013: Analysis of Annual Surveys at the Facility Level. PLoS Med. 2016;13(8): e1002088. doi: 10.1371/journal.pmed.1002088 27551917

17. Koenker R and Bassett G. Regression Quantiles. Econometrica. 1978;46(1):33–50.

18. Carmona S, Bor J, Nattey C, Maughan-Brown B, Maskew M, Fox MP, et al. Persistent high burden of advanced HIV disease among patients seeking care in South Africa’s national HIV program: data from a nationwide laboratory cohort. Clin Infect Dis. 2018;66(S2):S111–S117.

19. The IeDEA and COHERE Cohort Collaborations. Global Trends in CD4 Cell Count at the Start of Antiretorviral Therapy: Collaborative Study of Treatment Programs. Clin Infect Dis. 2018;66(6):893–903. doi: 10.1093/cid/cix915 29373672

20. Osler M, Hilderbrand K, Goemaere E, Ford N, Smith M, Meintjes G, et al. The continuing burden of advanced HIV disease over 10 years of increasing antiretroviral therapy coverage in South Africa. Clin Infect Dis. 2018;66(S2):S118–125.

21. Ousley J, Niyibizi AA, Wanjala S, Vandenbulcke A, Kirubi B, Omwoyo W, et al. High proportions of patients with advanced HIV are antiretroviral therapy experienced: hospitalization outcomes from 2 sub-Saharan African sites. Clin Infect Dis. 2018;66(S2):S126–132.

22. Mfinanga S, Chanda D, Kivuyo SL, Guinness L, Bottomley C, Simms V, et al. Cryptococcal meningitis screening and community-based early adherence support in people with advanced HIV infection starting antiretroviral therapy in Tanzania and Zambia: an open-label, randomised controlled trial. Lancet. 2015;385:2173–82. doi: 10.1016/S0140-6736(15)60164-7 25765698

23. Unitaid. HIV/AIDS Diagnostics Landscape. Geneva, Switzerland. 2015.

24. World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidelines. Supplement to the 2016 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva, Switzerland. 2018.

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