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Table 2 Extracted data WHO documents

From: Standard of care in advanced HIV disease: review of HIV treatment guidelines in six sub-Saharan African countries

 

WHO 2017

WHO 2021

Guideline information

 Country specific guideline

N/A

N/A

 Year of publication

2017

2021

 Specific section for AHD

Yes

Yes

Definition of AHD

 Definition

 < 200 CD 4 + cells/mm3 or WHO clinical stage 3 or 4

 < 200 CD 4 + cells/mm3 or WHO clinical stage 3 or 4

Screening

 CD4 testing at baseline

Yes

Yes

 Cryptococcal antigen

Yes

Yes

  - Population group

- CD 4 + cell count < 100 cells/mm3

- Recommended: CD4 < 100 cells/mm3

- Considered: CD4 < 200 cells/mm3

 Routine TB screening

Yes

Yes

  - Urine LAM

Yes

Yes

â—‹ Population group

- Symptoms suggesting TB and who have CD 4 + count ≤ 100 cells/mm3

- At any CD4 count if seriously ill#

- Inpatients ≤ 200 CD 4 + cells/mm3

- Outpatients ≤ 100 CD 4 + cells/mm3

- Any CD 4 + count

with symptoms or if seriously ill#

Prophylaxis

 Cotrimoxazole

Yes

Yes

  - Population group

- ≤ 350 CD 4 + cells/mm3 or clinical stage 3 or 4

- Any CD 4 + count in settings with high prevalence of malaria or severe bacterial infections

- CD 4 +  < 350 cells/mm3 or clinical stage 3 or 4

- Any CD 4 + count in settings with high prevalence of malaria or severe bacterial infection

  - Discontinuation

- Clinically stable on ART, with evidence of immune recovery and viral suppression

- Malaria and /or severe bacterial infections are highly prevalent: co-trimoxazole prophylaxis should be continued regardless of CD 4 + cell count or WHO clinical stage

- Clinically stable on ART+, with evidence of immune recovery and/or viral suppression&$

- Malaria and /or severe bacterial infections are highly prevalent: co-trimoxazole prophylaxis should be continued regardless of CD 4 + cell count or WHO clinical stage

 Pre-emptive therapy for cryptococcal antigenemia

Yes

Yes

 TB preventive therapy

Yes

Yes

  - Population group

Any

Any

Supportive care

 Specified adherence information

Yes

Yes

HIV treatment

 Recommended 1st line ART

Not addressed

DTG/3TC/TDF OR DTG/FTC/TDF

Delayed ART start

  - TB at non-neurological site

- Within first 8 weeks

- If CD 4 + cell counts < 50 cells/mm3 start within 2 weeks

Within 2 weeks

  - TB meningitis

2 months

4–8 weeks

  - Cryptococcal meningitis

4–6 weeks

4–6 weeks

  1. Bold: reference (WHO 2021)
  2. WHO 2017: guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy July 2017
  3. WHO 2021: consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach July 2021
  4. WHO 2023: providing care to people with advanced HIV disease who are seriously ill policy brief
  5. #Seriously ill: a seriously ill adult is defined as having any of the following danger signs: respiratory rate ≥ 30 breaths per minute; heart rate ≥ 120 beats per minute; or unable to walk unaided. Other clinical conditions, such as body temperature ≥ 39 Â°C, can also be considered based on local epidemiology and clinical judgement
  6. +Clinically stable adults are defined as individuals receiving ART for at least one year without any new WHO clinical stage 2, 3, or 4 events
  7. &CD4 cell count > 350 cells/mm3, with suppression of viral loads, is considered immune recovery (some countries may adopt a threshold of CD4 cell count > 500 cells/mm3)
  8. $WHO recognizes that in settings with low prevalence of malaria and severe bacterial infection in which co-trimoxazole is used primarily as prophylaxis for some AIDS-associated opportunistic infections (Pneumocystis jirovecii pneumonia and toxoplasmosis), guidelines exist for adults living with HIV discontinuing co-trimoxazole when there is evidence of suppressed viral loads and immune recovery at CD4 cell count > 200 cells/mm3 and they have been receiving ART for at least 1 year
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AIDS Research and Therapy

ISSN: 1742-6405

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