1. Advanced HIV: a WHO perspective
Nathan Ford & Meg Doherty
Dept HIV & Global Hepatitis Programme
World Health Organization

2. Late presentation: a persistent challenge
World Health Organization
28 November 2018
Late presentation: a persistent challenge
CD4 at start of ART
Advanced disease at enrolment (CD4 <350)
306
CD4 among people starting ART is rising, but still remains low overall, with many people still starting ART at CD4 less than 200. There are also many losses between diagnosis and start of ART.
167
IeDEA-WHO Collaboration 2015

4. WHO Recommendations on Differentiated Care
Data from recent trials shows that ART can be successfully initiated rapidly after HIV diagnosis – even on the same day. WHO recommends that efforts should be made to accelerrate start of ART. Patient readiness remains critically important
Duncombe C, et al. TMIH 2015; Waldrop G, et al. TMIH 2016

5. World Health Organization
28 November 2018
WHO recommendations
Cotrimoxazole prophylaxis
CD4 ≤350
ALL where SBI/malaria highly prevalent
Isoniazid prophylaxis
ALL (after active TB ruled out)
Cryptococcus antigen testing & pre-emptive therapy
CD4 <100
Urine Lam for TB diagnosis
Rapid ART
Co-formulated tablet in development
CD4 among people starting ART is rising, but still remains low overall, with many people still starting ART at CD4 less than 200. There are also many losses between diagnosis and start of ART.

6. Raising CD4 at start of ART
World Health Organization
28 November 2018
Raising CD4 at start of ART
Countries are rapidly adopting “Treat All”
Marked improvements in CD4 following guideline changes
As this slide shows, many countries have already adopted “Treat All” and others are planning to do so in the coming months

7. Rapid ART start
Evidence
New studies show that ART can be started on same day as HIV diagnosis
Data from recent trials shows that ART can be successfully initiated rapidly after HIV diagnosis – even on the same day. WHO recommends that efforts should be made to accelerrate start of ART. Patient readiness remains critically important
WHO position
Efforts should be made to reduce the time between HIV diagnosis and ART initiation based on an assessment of a person’s readiness

8. Areas for future Investigation
Roles of vaccines and vaccine preventable disease associated with early mortality (ie pneumonoccus infection)
Appropriate and rapid antibiotic treatment for those with fever and evidence of bacteremia