The World Health Organisation (WHO) has strongly recommended CD4 testing as the preferred method for identifying advanced HIV disease among people living with HIV, according to its newly released 2025 guidelines on advanced HIV care. The updated recommendations aim to improve early detection and reduce preventable illness and deaths linked to HIV, especially among vulnerable and high-risk patients.
The WHO defines advanced HIV disease in adults, adolescents, and children aged five years and above as having a CD4 cell count of fewer than 200 cells per cubic millimetre of blood. Advanced HIV disease remains the leading cause of AIDS-related deaths worldwide, even in countries that have achieved significant progress in HIV testing and treatment coverage. The organisation noted that serious health complications continue to occur despite progress toward the global 95–95–95 targets, which aim to ensure diagnosis, treatment, and viral suppression for most people living with HIV.
For children under the age of five, the WHO states that all children living with HIV should be considered as having advanced HIV disease at the time of diagnosis unless they have been on antiretroviral therapy (ART) for more than one year and are clinically stable. This approach allows healthcare providers to take extra precautions and provide intensive care early, reducing the risk of complications.
The WHO explained that the 2025 guidelines respond to the urgent need for better strategies to identify advanced HIV disease and improve outcomes for patients being discharged from hospitals. CD4 testing is recommended for people who are starting or restarting ART, those returning to care after a period of disengagement, individuals with suspected or confirmed treatment failure, and patients who are hospitalised, seriously ill, or clinically unstable.
In settings where CD4 testing is not available, the WHO advises using clinical staging to identify advanced HIV disease. CD4 testing can also help detect treatment failure when viral load testing is unavailable. Additionally, it supports decisions on stopping co-trimoxazole preventive therapy and determining eligibility for fluconazole prophylaxis.
The guidelines also highlight the importance of supporting hospitalised patients during the transition to outpatient care. Recommended measures include pre-discharge goal setting, medication review, follow-up phone calls, home visits by healthcare workers or peer supporters, and personalised care plans to reduce avoidable readmissions.
For people living with HIV who develop Kaposi’s sarcoma, a rare cancer affecting blood and lymph vessels, the WHO recommends treatments such as paclitaxel or pegylated liposomal doxorubicin. Overall, the guidelines stress early diagnosis, rapid initiation of ART, and improved clinical management to lower illness and death rates and support global efforts to eliminate HIV.
With Inputs from IANS