113 - advanced HIV Disease Among Adults in the African Cohort Study (AFRICOS)

Background: In the “test and treat” era, early ART may decrease the prevalence of advanced HIV disease (AHD), defined as having a CD4 cell count < 200 cells/µL or World Health Organization (WHO) clinical stage III or IV disease. We assessed trends in AHD and ART coverage and describe factors associated with AHD among adults living with HIV (LWH) across four countries before and during the “test and treat” era.

Methods: The African Cohort Study (AFRICOS) is a prospective cohort enrolling adults at risk for HIV or LWH from 12 facilities in Uganda, Kenya, Tanzania and Nigeria. Clinical history review and laboratory testing were performed at enrollment and every 6 months. Serum cryptococcal antigen screening (CrAg) was performed in a subset with CD4 < 200 at enrollment. Logistic regression was used to estimate odds ratios for factors associated with CD4 < 200.

Results: From January 2013–December 2019, 2934 adults LWH were enrolled (median age 38 years [interquartile range, 31–46 years], 41.5% men). Of 2903 with CD4 results at enrollment, 567 (19.5%) had CD4 < 200. Despite consistent increases in ART coverage since 2016, across all countries the prevalence of AHD did not decline below levels observed in 2013 until 2019. The prevalence of CD4 < 200 did not significantly decline from 11.9% (range 9.1–25.0%) in 2013 to 10.3% (range 0–16%) in 2019, p=0.7, while ART coverage increased from 74.7% (range 68.3–93.8%) in 2013 to 97.5% (range 86–100%) in 2019, p= < 0.01 (Figure 1). Factors associated with a higher risk of CD4 < 200 at enrollment were being enrolled in Tanzania, male sex, age >29 years, having a primary or some secondary education or above, and WHO stage II disease or higher. Factors associated with a lower risk of CD4 < 200 were >1 year since HIV diagnosis and being on ART for at least 6 months (Table 1). Among those with CD4 < 200 at enrollment, the most commonly reported comorbidities included HIV wasting syndrome (9.3%) and tuberculosis (TB) (2.3%); 19 (3.4%) of 564 adults screened were CrAg positive.Figure 1: Trends in Percentage of Participants with CD4 <200 and ART coverage at Study Enrollment by Country and Year
Table 1: Factors associated with CD4 <200 cells/mm3 at Study Enrollment


Conclusion: Despite the scale-up of ART in the era of “test and treat”, AHD prevalence has only recently trended downward. Continued efforts towards early HIV diagnosis and timely ART initiation are needed to reduce the risk for CD4< 200. Strategies to increase TB screening, prophylaxis, and treatment are essential to reduce morbidity.

Presenting Author(s)

• 

  Ikwo Oboho, MD, ScM

  Medical Epidemiologist
  Centers for Disease Control and Prevention, Atlanta, GA USA
  Atlanta, GA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• AE

  Allahna L. Esber, PhD

  Research Analyst
  The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD and Walter Reed Army Institute of Research, Silver Spring, MD
  Silver Spring, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• ND

  Nicole Dear, MPH

  Research Analyst
  U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
  Silver Spring, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• HP

  Heather Paulin, MD

  Medical Officer
  CDC
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MI

  Michael Iroezindu, MB, BS

  Site Principal Investigator
  U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
  Silver Spring, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• EB

  Emmanuel Bahemana, MD, MPH

  Research/AFRICOS Study Coordinator
  U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA, HJF Medical Research International, Mbeya, Tanzania
  Mbeya, Mbeya, Tanzania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• HK

  Hannah Kibuuka, MB.ChB, M.Mmed, MPH

  Executive Director, Makerere University Walter Reed Project
  Makerere University-Walter Reed Project, Kampala, Uganda
  Kampala, Kampala, Uganda

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JO

  John Owuoth, MB, BS

  Site Principal Investigator
  U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
  Silver Spring, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JM

  Jonah Maswai, MB, BS

  Site Principal Investigator
  Walter Reed Army Institute of Research, Silver Spring, MD
  Silver Spring, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• TC

  Trevor A. Crowell, MD, PhD

  Associate Director for Cohort Development and Data Analysis
  Walter Reed Army Institute of Research, Silver Spring, MD
  Bethesda, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JA

  Julie A. Ake, MD

  Deputy Director
  Walter Reed Army Institute of Research, Silver Spring, MD
  Silver Spring, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• CP

  Christina Polyak, MD MPH

  Associate Director of Clinical Research
  The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD and Walter Reed Army Institute of Research, Silver Spring, MD
  Bethesda, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.