The advanced HIV disease research landscape

Advanced HIV disease (defined in persons living with HIV with a CD4 cell count of <200cells/mm3 or presenting with a WHO Stage 3/4 AIDS-defining illness) poses a challenge to many countries globally, and is responsible for significant mortality and morbidity among people living with HIV.

In 2017, WHO recommended a package of care for the prevention and management of advanced HIV disease. The package was composed of screening tests, diagnostics, prophylaxis, rapid ART initiation and enhanced adherence counselling. Since the development of these recommendations, a number of important studies as well as interventions have emerged for potential use in advanced HIV disease. In 2023, WHO commissioned the development of a landscaping exercise followed by an expert consultation on the AHD research landscape. The expert consultation brought together over 70 subject matter experts, representatives of civil society, ministries of health and implementation partners.

This report summarizes both the findings from the landscaping exercise and the report of the expert consultation. Specifically, it provides an overview of 9 key focus areas in advanced HIV disease, starting with CD4 testing as the entry point into differentiated advanced HIV disease care, followed by sections on the 3 leading causes of mortality in advanced HIV disease – TB, cryptococcal meningitis and severe bacterial infections. The findings in this report will support WHO in the update of the guidelines for advanced HIV disease.