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Modelling the impact of CD4 testing on mortality from TB and cryptococcal meningitis among patients with advanced HIV

Ikwo Kitefre Oboho1, Heather Paulin1, Carl Corcoran1

  • 1Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Journal of the International AIDS Society
|March 7, 2023
PubMed

Insights

Baseline CD4 testing helps prevent deaths from tuberculosis and cryptococcal meningitis in people with advanced HIV disease starting antiretroviral therapy. Retaining CD4 testing averts significant mortality, though resource allocation requires careful consideration.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Immunology

Background:

  • Antiretroviral therapy (ART) scale-up has not eliminated opportunistic infections in people living with HIV (PLHIV) with advanced HIV disease (AHD).
  • The shift to viral load testing has reduced the identification of AHD, increasing mortality risk.
  • Opportunistic infections like tuberculosis (TB) and cryptococcal meningitis (CM) remain leading causes of death in AHD patients.

Purpose of the Study:

  • To project deaths from TB and CM among PLHIV initiating ART with CD4 <200 cells/mm³.
  • To evaluate the impact of baseline CD4 testing on averting deaths from TB and CM.
  • To compare projected mortality with and without CD4 testing in nine African countries.

Main Methods:

  • Utilized official estimates and epidemiological data for projections.
  • Modeled the reduction in deaths based on diagnostic and therapeutic protocol performance.
  • Compared projected TB and CM deaths in the first year of ART (2019-2024) with and without CD4 testing.

Main Results:

  • CD4 testing algorithms avert 31% to 38% of TB and CM deaths in the first year of ART.
  • The number of CD4 tests needed per death averted varies significantly by country.
  • South Africa requires approximately 101 CD4 tests per death averted, while Kenya requires 917.

Conclusions:

  • Retaining baseline CD4 testing is crucial for averting deaths from TB and CM in AHD patients.
  • National programs must balance the cost of CD4 testing access with other HIV priorities.
  • Resource allocation for CD4 testing should be carefully considered within broader HIV strategies.
Abstract

Keywords:
CD4 testingTB mortalityadvanced HIV diseasecryptococcal meningitisdeaths avertedmortality

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