A Count We Still Count on The Importance of CD4 in the Treat-All Era Tom Chiller MD, MPHTM Mycotic Diseases Branch Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Mycotic Diseases Branch

1980s - 1990s Clinical Evaluation

1980s - 1990s Clinical Evaluation

2000s Treatment Initiation

2015: Treat-All Era Clinical Evaluation

2015: Treat-All Era Clinical Evaluation Short-term Goal of Test and Treat: Prevent transmission …but will not immediately affect mortality 2015: Treat-All Era Clinical Evaluation

Universal Test and Treat The Latest from WHO Universal Test and Treat

…but advanced disease still priority population The Latest from WHO …but advanced disease still priority population

CD4 counts still low with expanded treatment Trends CD4 at Presentation Trends CD4 at Initiation 2.Materials andMethods The records of 4,042 HAART-na¨ıve, HIV-positive patients who registered at the HIV clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja, between December 2006 and June 2010 were retrospectively reviewed. Overall totals aren’t sum of column totals because exlude CD4 > 500, while column parenthetical totals are for all screened of that sex, including those with CD4 > 500 Siedner et al, CID 2015

Gaolathe et al. Lancet 2016. 3(5): e221–230 Botswana has come close to achieving 90-90-90 Botswana 90% 83.3% Know their status Know their status 90% 87.4% Receiving ART Receiving ART 90% 96.5% Virally suppressed Virally suppressed Gaolathe et al. Lancet 2016. 3(5): e221–230

Jarvis et al, unpublished Change in annual CM incidence HIV-infected On ART Jarvis et al, unpublished

Jarvis et al, unpublished Change in annual CM incidence projected HIV-infected On ART Jarvis et al, unpublished

Jarvis et al, unpublished Change in annual CM incidence observed HIV-infected On ART Jarvis et al, unpublished

Scaling Up Viral Load in Namibia Prior to VL Scale-up Show old vs new with arrow Move results to action to new slide VL coverage previously 54% # Monthly CD4 Tests Previously

Scaling Up Viral Load in Namibia Prior to VL Scale-up Following VL Scale-up Show old vs new with arrow Move results to action to new slide VL coverage previously 54% VL coverage now 94% # Monthly CD4 Tests Previously

Scaling Up Viral Load in Namibia Prior to VL Scale-up Following VL Scale-up Show old vs new with arrow Move results to action to new slide VL coverage previously 54% VL coverage now 94% CD4 Tests Performed 10% # Monthly CD4 Tests Previously

POC CD4 Devices 1 2 Microchip or Colormetric Aptamer Based Biosensor Prototype 3

Thank you! “The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.”