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

Lamp, Katherine; McGovern, Seth; Fong, Youyi; Atem, Charles; Nzuobontane, Divine; Bollinger, Timothy; Jani, Ilesh; Sitoe, Nádia; Kiyaga, Charles; Senyama, George; Mangwendeza, Phibeon Munyaradzi; Mtapuri-Zinyowera, Sekesai; Doi, Naoko; Peter, Trevor; Sacks, Jilian A.; Vojnov, Lara

doi:10.1371/journal.pone.0226987

Cited by 13 publications

(8 citation statements)

References 14 publications

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“…One‐third of these HIV‐positive TB contacts had AHD (29%, 9/31), either immunologically defined (CD4 <200 cells/μL in 5/9) and/or clinically defined (WHO stage 3 or 4 found in 4/9). The overall proportion of AHD is in line with other AHD surveys from the region [ 1 , 2 , 3 ]. TB programme managers should factor in AHD screening and linkage to care of HIV‐positive TB contacts when discussing the efficiency of community TB contact‐tracing interventions, which have been often regarded as low efficient when the benefit is set only in their TB diagnosis yield [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Discussionsupporting

confidence: 87%

“…Despite the reduction in HIV incidence and AIDS‐mortality resulting from expanded access to antiretroviral treatment (ART) globally, more than one‐third of people living with HIV (PLHIV) continue to present to care with advanced HIV disease (AHD) in many low and middle income countries [ 1 , 2 , 3 ]. AHD is defined as having <200 CD4 cells/μL or World Health Organization (WHO) clinical stage 3 or 4 criteria [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Improved detection and management of advanced HIV disease through a community adult TB‐contact tracing intervention with same‐day provision of the WHO‐recommended package of care including ART initiation in a rural district of Mozambique

et al. 2021

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Introduction AIDS‐mortality remains unacceptably high in sub‐Saharan Africa, largely driven by advanced HIV disease (AHD). We nested a study in an existing tuberculosis (TB) contact‐tracing intervention (Xpatial‐TB). The aim was to assess the burden of AHD among high‐risk people living with HIV (PLHIV) identified and to evaluate the provision of the WHO‐recommended package of care to this population. Methods All PLHIV ≥14 years old identified between June and December 2018 in Manhiça District by Xpatial‐TB were offered to participate in the study if ART naïve or had suboptimal ART adherence. Consenting individuals were screened for AHD. Patients with AHD (CD4 < 200 cells/μL or WHO stage 3 or 4) were offered a package of interventions in a single visit, including testing for cryptococcal antigen (CrAg) and TB‐lipoarabinomannan (TB‐LAM), prophylaxis and treatment for opportunistic infections, adherence support or accelerated ART initiation. We collected information on follow‐up visits carried out under routine programmatic conditions for six months. Results A total of 2881 adults were identified in the Xpatial TB‐contact intervention. Overall, 23% (673/2881) were HIV positive, including 351 TB index (64.2%) and 322 TB contacts (13.8%). Overall, 159/673 PLHIV (24%) were ART naïve or had suboptimal ART adherence, of whom 155 (97%, 124 TB index and 31 TB‐contacts) consented to the study and were screened for AHD. Seventy percent of TB index‐patients (87/124) and 16% of TB contacts (5/31) had CD4 < 200 cells/µL. Four (13%) of the TB contacts had TB, giving an overall AHD prevalence among TB contacts of 29% (9/31). Serum‐CrAg was positive in 4.6% (4/87) of TB‐index patients and in zero TB contacts. All ART naïve TB contacts without TB initiated ART within 48 hours of HIV diagnosis. Among TB cases, ART timing was tailored to the presence of TB and cryptococcosis. Six‐month mortality was 21% among TB‐index cases and zero in TB contacts. Conclusions A TB contact‐tracing outreach intervention identified undiagnosed HIV and AHD in TB patients and their contacts, undiagnosed cryptococcosis among TB patients, and resulted in an adequate provision of the WHO‐recommended package of care in this rural Mozambican population. Same‐day and accelerated ART initiation was feasible and safe in this population including among those with AHD.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Improved detection and management of advanced HIV disease through a community adult TB‐contact tracing intervention with same‐day provision of the WHO‐recommended package of care including ART initiation in a rural district of Mozambique

et al. 2021

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“…Evidence suggests that even in access to treatment for all patients, a particular focus should be on AHD patients to reduce the high risk of HIV-related complications [ 12 ]. Prompt and early identification of patients with advanced HIV disease through CD4 testing is essential to reduce the burden of HIV in order to provide a specific treatment [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Baseline CD4 Cell Counts and Advanced HIV Disease among Male and Female HIV-Positive Patients in Iran: A Retrospective Cohort Study

Afrashteh

Fararouei

Ghaem

et al. 2022

Journal of Tropical Medicine

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Despite the recommendation for early diagnosis and rapid initiation of HIV treatment, more than half of patients are in an advanced stage of HIV disease in Iran. This study aimed to investigate the factors related to baseline CD4 cell count and advanced HIV disease (AHD) in Southern Iran. The study comprised all adults between 15 and 87 years of age who were newly diagnosed with HIV in Southern Iran. Linear and logistic regressions were used to identify baseline CD4 cell count predictors and AHD, respectively. A total of 820 (53.9%) HIV-infected individuals over 15 years of age were at the AHD stage. Based on the results of the multiple logistic regression, older age at diagnosis (OR≥40/<30 = 2.68, 95% CI = 1.38–5.19), gender (ORfemale/male = 0.62, 95% CI = 0.44–0.85), HIV/TB coinfection (ORyes/no = 1.98, 95% CI = 1.29–3.02), HIV/HBV coinfection (ORyes/no = 1.58, 95% CI = 1.07–2.38), and hemoglobin (OR = 0.89, 95% CI = 0.85–0.92) were directly associated with AHD in HIV/AIDS patients. As suggested by a linear regression model, factors including gender (B Female = 44.12, 95% CI:17.86, 70.38), older age (B ≥ 40 = −111.99, 95% CI:−174.70, −49.27), higher education level (B = 35.65, 95% CI:5.34, 65.97), WHO clinical stage (BIV = −254.53, 95% CI−298.82, −210.24), and hemoglobin (B = 5.23, 95% CI:0.25, 10.20) were significantly associated with CD4 count.The prevalence of AHD in patients was high in Iran. Our results suggested that several demographic and clinical factors are significantly associated with the baseline CD4 cell count and AHD. Targeted HIV testing, implementation of screening programs for early detection, and access to care services to assure early ART are recommended to improve the clinical status and quality of life of the patients.

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“…HIV-infected patients in South Africa often present for treatment with advanced disease at lower CD4+ T cell counts and with higher viral loads [23,24]. This is associated both with an increased incidence of opportunistic and non-communicable complications of HIV infection and with longer and more severe chronic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of human immunodeficiency virus associated disseminated intravascular coagulation

Mayne

Louw

2022

PLoS ONE

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Introduction Disseminated intravascular Coagulation (DIC) is a thrombotic microangiopathy which may complicate a number of severe disease processes including sepsis. Development of microvascular thromboses results in consumption of coagulation factors and platelets and ultimate bleeding. Patients with HIV infection (PWH) often present with baseline dysregulation of the coagulation system which may increase severity and derangement of DIC presentation. Previously, we have shown that HIV is a significant risk factor for development of DIC. Methodology We conducted a retrospective record review of all DIC screens submitted to our tertiary coagulation laboratory in Johannesburg, South Africa, over a one year period and compared the laboratory presentation of DIC in PWH with presentation of DIC in patients without HIV infection. Results Over the year, 246 patients fulfilled the International Society of Thrombosis and Haemostasis (ISTH) diagnostic criteria for DIC– 108 were confirmed HIV-infected and 77 were confirmed uninfected. PWH and DIC presented at a significantly earlier age (41 vs 46 years respectively, p<0.02). The prothrombin time was significantly more prolonged (30.1s vs 26.s), the d-dimer levels were substantially higher (5.89mg/L vs 4.52mg/L) and the fibrinogen (3.92g/L vs 1.73g/L) and platelet levels (64.8 vs 114.8x109/l) were significantly lower in PWH. PWH also showed significant synthetic liver dysfunction and higher background inflammation. Conclusion PWH who fulfil the diagnostic criteria for DIC show significantly more dysregulation of the haemostatic system. This may reflect baseline abnormalities including endothelial dysfunction in the context of inflammation and liver dysfunction.

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

Abstract: Background

Cited by 13 publications

References 14 publications

Improved detection and management of advanced HIV disease through a community adult TB‐contact tracing intervention with same‐day provision of the WHO‐recommended package of care including ART initiation in a rural district of Mozambique

Improved detection and management of advanced HIV disease through a community adult TB‐contact tracing intervention with same‐day provision of the WHO‐recommended package of care including ART initiation in a rural district of Mozambique

Factors Associated with Baseline CD4 Cell Counts and Advanced HIV Disease among Male and Female HIV-Positive Patients in Iran: A Retrospective Cohort Study

Diagnosis of human immunodeficiency virus associated disseminated intravascular coagulation

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