Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment — 10 Countries, 2004–2015
Authors: Andrew F. Auld, Ray W. Shiraishi, Ikwo Oboho, Christine Ross, Moses Bateganya, Valerie Pelletier, Jacob Dee, Kesner Francois, Nirva Duval, Mayer Antoine, Chris Delcher, Gracia Desforges, Mark Griswold, Jean Wysler Domercant, Nadjy Joseph, Varough Deyde, Yrvel Desir, Joelle Deas Van Onacker, Ermane Robin, Helen Chun, Isaac Zulu, Ishani Pathmanathan, E. Kainne Dokubo, Spencer Lloyd, Rituparna Pati, Jonathan Kaplan, Elliot Raizes, Thomas Spira, Kiren Mitruka, Aleny Couto, Eduardo Samo Gudo, Francisco Mbofana, Melissa Briggs, Charity Alfredo, Carla Xavier, Alfredo Vergara, Ndapewa Hamunime, Simon Agolory, Gram Mutandi, Naemi N. Shoopala, Souleymane Sawadogo, Andrew L. Baughman, Adebobola Bashorun, Ibrahim Dalhatu, Mahesh Swaminathan, Dennis Onotu, Solomon Odafe, Oseni Omomo Abiri, Henry H. Debem, Hank Tomlinson, Velephi Okello, Peter Preko, Trong Ao, Caroline Ryan, George Bicego, Peter Ehrenkranz, Harrison Kamiru, Harriet Nuwagaba-Biribonwoha, Gideon Kwesigabo, Angela A. Ramadhani, Kahemele Ng’wangu, Patrick Swai, Mohamed Mfaume, Ramadhani Gongo, Deborah Carpenter, Timothy D. Mastro, Carol Hamilton, Julie Denison, Fred Wabwire-Mangen, Olivier Koole, Kwasi Torpey, Seymour G. Williams, Robert Colebunders, Julius N. Kalamya, Alice Namale, Michelle R. Adler, Bridget Mugisa, Sundeep Gupta, Sharon Tsui, Eric van Praag, Duc B. Nguyen, Sheryl Lyss, Yen Le, Abu S. Abdul-Quader, Nhan T. Do, Modest Mulenga, Sebastian Hachizovu, Owen Mugurungi, Beth A. Tippett Barr, Elizabeth Gonese, Tsitsi Mutasa-Apollo, Shirish Balachandra, Stephanie Behel, Trista Bingham, Duncan Mackellar, David Lowrance, Tedd V. Ellerbrock
Journal: MMWR Morbidity and Mortality Weekly Report (2017)

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.