Limited access to CD4 tests misses late diagnoses and advanced HIV disease (AHD)
8 August 2025. Related: Conference reports, Treatment strategies, Guidelines, Coinfections and complications, IAS 13th Kigali 2025.
Simon Collins, HIV i-Base
A poster presented at IAS 2-25 included the complications and harm caused by the steady withdrawal of routine access to CD4 testing in many low- and middle0income countries. [2]
This prospective study included 622 adults >15 years who were diagnosed with HIV at ten public health clinics in central Ethiopia between 2022-2024.
Median age was 35 and just under 60% were women.
Based on WHO staging alone, 229/622 participants (37%) were categorised as Stage 1/2. However, CD4 counts available for 118/229 showed that one-third of those diagnosed as Stage 1/2 actually had CD4 counts <200 cells/mm3.
Using both staging and the available CD4 counts, 41% of the overall cohort were diagnosed as having advanced HIV. However, this will still be an underestimate because CD4 testing was only available for 35% overall.
AHD was more common among: men (aOR 1.47 [95% CI: 1.01 to 2.16]), people >50 years (aOR 2.64 [95% CI: 1.18 to 5.90]) and rural residents (aOR 2.98 [95% CI: 1.56 to 5.67]).
The researchers concluded that lack of routine CD4 testing at initiation of ART led to missed identification of AHD in nearly one-third of people staged as WHO 1 or 2 who would then miss important investigations and interventions.
comment
This shows that that WHO staging is likely to under diagnose rates of AHD when CD4 testing is not routinely available.
Importantly, one of the changes to the new WHO guidelines presented at IAS 2025 is a new recommendation for CD4 count monitoring to be recommended for the management of AHD, rather than WHO staging. [2]
Reference
- Abdulahi IJ et al. Advanced HIV disease is common among people with HIV newly enrolled to care in Central Ethiopia in the Test-and-Treat Era. IAS 2025. 13-16 July 2025. ePoster EP0055.
https://conference.ias2025.org/media-758-advanced-hiv-disease-remains-common-among-people-with-hiv-newly-enrolled-to-care-in-centra - IAS 2025: WHO major updates on injectables, AHD, infant feeding and peer support. HTB (2 August 2025).
https://i-base.info/htb/52185