Advanced HIV Disease in East Africa and Nigeria, in The African Cohort Study (AFRICOS).

BACKGROUND: Earlier antiretroviral therapy (ART) may decrease progression to advanced HIV disease (AHD) with CD4 <200 cells/mm3 or clinical sequelae. We assessed factors associated with AHD among people living with HIV (PLHIV) before and during the "test and treat" era.

SETTING: The African Cohort Study (AFRICOS) prospectively enrolls adults with and without HIV from 12 clinics in Uganda, Kenya, Tanzania, and Nigeria.

METHODS: Enrollment evaluations included clinical history, physical examination, and laboratory testing. Generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for factors associated with CD4 <200 at study visits.

RESULTS: From 2013-2021, 3059 PLHIV with available CD4 at enrollment were included; median age was 38 years [interquartile range: 30-46] and 41.3% were men. From 2013 to 2021, the prevalence of CD4 <200 decreased from 10.5% to 3.1% while the percentage on ART increased from 76.6% to 100% (p <0.001). Factors associated with higher odds of CD4 <200 were male sex (aOR 1.56 [CI 1.29-1.89]), being 30-39 years (1.42 [1.11-1.82]) or older (compared to <30), World Health Organization stage 2 disease (1.91 [1.48-2.49]) or higher (compared to stage 1), and HIV diagnosis eras 2013-2015 (2.19 [1.42-3.37]) or later (compared to <2006). Compared to ART naïve, unsuppressed participants, being viral load suppressed on ART, regardless of ART duration, was associated with lower odds of CD4 <200 (<6 months on ART: 0.45 [0.34-0.58]).

CONCLUSION: With ART scale-up, AHD has declined. Efforts targeting timely initiation of suppressive ART may further reduce AHD risk.