Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.
;
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;
(2017)
Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.
MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT, 66 (21).
pp. 558-563.
ISSN 0149-2195
DOI: 10.15585/mmwr.mm6621a3
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.
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