The World Health Organization (WHO) has strongly recommended CD4 tests as the preferred method to identify advanced HIV disease among individuals living with HIV. This new recommendation is part of the 2025 guidelines on advanced HIV disease. Advanced HIV disease is defined by the WHO as a CD4 cell count less than 200 cells/mm3 in adults, adolescents, and children aged five and above. It is a significant cause of AIDS-related deaths among people living with HIV, even in areas with good HIV testing and treatment coverage.
The WHO emphasized that all children under five years old living with HIV should be considered to have advanced HIV disease at presentation unless they have been on antiretroviral therapy (ART) for over a year and are deemed clinically stable. The 2025 guidelines aim to address the need for better approaches to identify advanced HIV disease and improve outcomes for individuals living with HIV after hospital discharge.
In settings where CD4 testing is unavailable, the WHO stated that clinical staging can be used to identify advanced HIV disease. CD4 testing is recommended for various scenarios, including initiating or reinitiating ART, re-engaging in care, experiencing treatment failure, being hospitalized, or considered clinically unstable. Additionally, CD4 testing can assist in identifying treatment failure when viral load testing is not an option and determining eligibility for certain prophylactic treatments.
The WHO also highlighted interventions for hospitalized individuals with HIV to aid in transitioning to outpatient care and reducing readmissions. These interventions may involve goal setting before discharge, medication review, care planning, follow-up calls, home visits by healthcare providers or peer supporters, and personalized support. Furthermore, the WHO suggested specific pharmacological treatments for people living with HIV and Kaposi’s sarcoma, emphasizing early detection, prompt ART initiation, and optimized clinical management to lessen morbidity and mortality.
