Managing Advanced HIV Disease in a Public Health Approach

Area of Science:

• Public Health
• Infectious Diseases
• HIV/AIDS Management

Background:

• Over a third of individuals initiate antiretroviral therapy (ART) with advanced human immunodeficiency virus (HIV).
• A growing number of patients with advanced HIV re-engage in care after disengagement.
• Leading causes of mortality in advanced HIV include tuberculosis, severe bacterial infections, and opportunistic infections like cryptococcal meningitis.

Purpose of the Study:

• To outline the World Health Organization's (WHO) 2017 guidelines for managing advanced HIV disease.
• To detail a standardized package of care based on major causes of morbidity and mortality.
• To incorporate findings from recent randomized trials demonstrating mortality reduction with simplified interventions.

Main Methods:

• Review and synthesis of existing recommendations and new trial data.
• Development of a standardized care package for adults, adolescents, and children with advanced HIV.
• Inclusion of specific interventions such as opportunistic infection screening and prophylaxis.

Main Results:

• The WHO guidelines recommend a package of care for advanced HIV disease.
• The package includes screening and prophylaxis for opportunistic infections, such as fluconazole for cryptococcal antigen-positive individuals.
• Rapid ART initiation and intensified adherence support are recommended for all patients with advanced HIV.

Conclusions:

• The recommended care package aims to reduce morbidity and mortality in advanced HIV disease.
• Simplified intervention packages have shown significant mortality reduction.
• A public health approach integrating screening, prophylaxis, and rapid ART initiation is crucial for managing advanced HIV.