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Patients re-engaging with HIV care in Guatemala: Prioritizing CD4 counting and screening for histoplasmosis and

Narda Medina1, Ana Alastruey-Izquierdo2,3, Oscar Bonilla4

  • 1Asociación de Salud Integral, Guatemala City, Guatemala.

HIV Medicine
|February 17, 2025
PubMed

Insights

Patients re-engaging in care after HIV treatment interruption face high rates of advanced HIV disease and opportunistic infections like tuberculosis and histoplasmosis. Routine CD4 testing is crucial for early detection and intervention.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Immunology

Background:

  • Antiretroviral therapy (ART) discontinuation contributes to advanced HIV disease (AHD) and opportunistic infections.
  • This study examines patients re-engaging in care after ART interruption, comparing them to newly diagnosed HIV patients.

Purpose of the Study:

  • To analyze the burden of tuberculosis and histoplasmosis in patients re-engaging in care versus newly diagnosed HIV patients.
  • To highlight the need for timely CD4 testing and comprehensive diagnostics for advanced HIV disease.

Main Methods:

  • A diagnostic package for opportunistic infections (tuberculosis, histoplasmosis) was implemented in Guatemala (2017-2019).
  • 1379 adults re-engaging in care and 3412 newly diagnosed HIV patients were enrolled across 13 facilities.
  • Data included demographics, lab results, and outcomes.

Main Results:

  • AHD prevalence was high in both groups: 54% in re-engaging patients and 50.1% in newly diagnosed patients.
  • Significant CD4 testing gaps existed: 34.5% un-tested in re-engaging vs. 21.1% in newly diagnosed.
  • Incidence rates for tuberculosis and histoplasmosis were high in re-engaging patients (9.7% and 8.3%) and similar to newly diagnosed patients.

Conclusions:

  • Patients re-engaging in care require similar diagnostic and care pathways as newly diagnosed individuals.
  • Routine, immediate CD4 testing is essential to identify AHD and guide treatment.
  • Early detection and targeted interventions are critical to reduce AIDS-related mortality.
Abstract

Keywords:
HIVLatin Americafungal infectionshistoplasmosistuberculosis

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