This virtual learning episode will discuss the global challenges, clinical considerations, and recommendations on the use of CD4 testing to identify advanced HIV disease and viral load for treatment monitoring among people living with HIV through a series of presentations, including case-based learning and a Q and A session.
13 September 2023 - 16:00-17:30 CEST
Registration is required beforehand.
The series will be held in English. Translation will be available in French, Russian and Portuguese. Materials from the webinar will be available for those who have registered as open access.
Background
CD4 cell count
In 2015, WHO recommended that all people living with HIV start ART irrespective of clinical or immune status. Most national guidelines have adopted this recommendation. However, despite this progress, up to half the people living with HIV continue to present to care with advanced HIV disease.
Advanced HIV disease includes people presenting to care for the first time following an HIV diagnosis and people who have treatment failure and consequent decline in CD4 cell count. Individuals who had previously initiated ART and are re-engaging with care after a period of ART interruption should be assessed for advanced HIV disease and should be offered the advanced HIV disease package as appropriate.
People presenting with advanced HIV disease are at high risk of death, even after starting ART, with the risk increasing with decreasing CD4 cell count, especially with CD4 cell count <100 cells/mm3. Thus, CD4 cell count estimation is a gateway to the identification of those at elevated risk of co-infections or comorbidities – i.e., advanced HIV disease.
Advanced HIV disease is also associated with increased risk of opportunistic infections, immune reconstitution inflammatory syndrome, incomplete immune reconstitution, higher viral reservoirs, inflammation, increased risk of AIDS-related and non-AIDS-related comorbidities, use of more health-care services and more frequent monitoring needs. Therefore, timely identification of advanced HIV disease with a CD4 test is a vital activity in HIV programmes worldwide.
Viral load monitoring
Monitoring people on ART is important to ensure successful treatment, identify adherence problems and quickly identify treatment failure. Compared with clinical or immunological monitoring, viral load testing provides an early and more accurate indication of treatment failure and allows programmes to optimize the ART regimens people living with HIV receive, thus reducing the accumulation of drug resistance mutations and improving clinical outcomes. Measuring viral load also helps to discriminate between treatment failure and non-adherence, following enhanced adherence support. Further, viral load testing gives clients a measure of understanding, control, and motivation to adhere to treatment and understand the status of their HIV infection.
WHO TRACK initiative
WHO “TRACK” Initiative (Technical Resources for Advanced HIV Capacity and Knowledge) is a digital platform and series of webinars to enable and promote the sharing of knowledge and best practices to promote high quality care for people with advanced HIV disease. This digital learning series has a specific focus on the WHO AFRO region but remains relevant for other WHO regions.