1. 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

2. 1980s s
Clinical Evaluation

3. 1980s s
Clinical Evaluation

4. 2000s
Treatment Initiation

5. 2015: Treat-All Era
Clinical Evaluation

6. 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

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

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

9. 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

10. Gaolathe et al. Lancet 2016. 3(5): e221–230
Botswana has come close to achieving
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 (5): e221–230

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 Jarvis et al, unpublished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Jarvis et al, unpublished

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 Jarvis et al, unpublished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Jarvis et al, unpublished

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 Jarvis et al, unpublished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Jarvis et al, unpublished

14. Scaling Up Viral Load in Namibia
Prior to VL Scale-up
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VL coverage previously
54%
# Monthly CD4 Tests Previously

15. 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

16. 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

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

18. 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.”