CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

approach for people living with HIV, many in low- and middle-income countries still present with AHD at diagnosis, increasing their risk of opportunistic infections and mortality. CD4 testing is crucial for identifying AHD and ensuring proper management, and the WHO recommends routine CD4 testing for all starting or restarting antiretroviral therapy (ART). This study evaluated CD4 testing coverage and AHD prevalence at U.S. Agency for International Development (USAID) sites supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Methods: The PEPFAR Monitoring, Evaluation, and Reporting (MER) framework introduced CD4 count disaggregation (<200, ≥200, Unknown) in October 2023. This study analyzed MER data from October 1, 2023, to June 30, 2024 from USAID implementing sites in 42 PEPFAR supported countries. High-risk clients were classified into two groups: those newly initiating ART (TX_NEW) and those reinitiating ART after a treatment interruption of ≥6 months (RTT-IIT). Descriptive statistics were used to assess CD4 testing rates and AHD prevalence based on HIV diagnosis, ART initiation, CD4 testing, and sex assigned at birth. Results: The analysis included 645,342 high-risk clients, comprising 471,563 (73%) TX_NEW and 173,779 (27%) RTT-IIT. CD4 testing was reported for 267,948 (42%) high-risk clients, with a higher prevalence of CD4 counts <200 among TX_NEW (27%) compared to RTT-IIT (23%). AHD prevalence was higher among cisgender males (33% TX_NEW, 28% RTT-IIT) compared to females (23% TX_NEW, 20% RTT-IIT). Countries with CD4 testing coverage exceeding 50% had lower AHD prevalence (26% TX_NEW, 22% RTT-IIT) than those with coverage below 50% (28% TX_NEW, 31% RTT-IIT). Conclusions: AHD continues to be a challenge for clients starting or reinitiating ART, particularly among men. Critical gaps in CD4 testing coverage for high-risk individuals exacerbate this issue. Even in countries with high CD4 testing rates, AHD prevalence remains elevated, highlighting the urgent need to enhance efforts toward earlier HIV diagnosis and rapid treatment initiation. Strengthening these efforts is crucial to improving clinical outcomes and achieving the goal of ending AIDS as a public health threat by 2030.

the proportion of people who did not know their status decreased from 31 to 17%, and the proportion of people with suppressed viral load increased from 60 to 77%. Pooled across the five countries, 10.4% (95% CI [CI] 9.8–11.0%) of PLHIV had a CD4 cell count <200cells/mm 3 in PHIA round 1 and 6.8% (CI 6.2–7.4%) in PHIA round 2. Stratified by the HIV treatment cascade, AHD prevalence remained similar among people who did not know their status (16.1%, CI 14.4–18.0%, to 12.7%, CI 10.5–15.2%), increased among people who knew their status but were not on ART (20.8%, CI 17.7–24.3% to 26.7%, CI 20.1–34%), but decreased across all other categories of the treatment cascade. Among people on ART who were not virally suppressed, AHD prevalence decreased from 36.7% (CI 34.0–41.4%) to 29.8% (CI 25.0–35.0%) and among people with viral suppression it almost halved from 6.4% (CI 5.7–7.1%) to 3.3% (CI: 2.8–3.8%, Figure). These effects were consistent across the five countries, were similar for men and women, and were more pronounced in urban than rural areas and among older ages. Among youth aged 15–24 years, AHD prevalence increased from 5.0% (CI 3.9–6.3%) to 6.1% (CI 4.3–8.2%). Conclusions: The prevalence of AHD decreased across five countries, primarily due to advances in testing, knowledge of status and treatment. However, AHD persists among people with new HIV diagnosis, and among young people, which requires attention. Although household surveys underestimate AHD by excluding potential survey participants who are hospitalized, the need for continued CD4 count testing and the delivery of the package of care for people with AHD is clear.

Poster Abstracts

1133 Advanced HIV Disease in Individuals Already in Care: Incidence and Comparison With Late Presentation Andrea Antinori 1 , Ashley Roen 2 , Alessandro Cozzi-Lepri 2 , Andrea Giacomelli 3 , Annalisa Saracino 4 , Antonio Di Biagio 5 , Carlo Torti 6 , Davide Checchi 7 , Massimo Puoti 8 , Eugenia Quiros-Roldan 9 , Silvia Nozza 10 , Sergio Lo Caputo 11 , Enrico Girardi 12 , Annalisa Mondi 12 , for the Icona Foundation Study Group 1 National Institute for Infectious Diseases L Spallanzani, Rome, Italy, 2 University College London, London, UK, 3 Luigi Sacco University Hospital, Milan, Italy, 4 University of Bari, Bari, Italy, 5 University of Genoa, Genoa, Italy, 6 Catholic University of the Sacred Heart, Milan, Italy, 7 Hospital of Rome Tor Vergata, Rome, Italy, 8 ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, 9 ASST Spedali Civili di Brescia, Brescia, Italy, 10 San Raffaele Vita-Salute University, Milan, Italy, 11 Università degli studi di Foggia, Foggia, Italy, 12 IRCCS Lazzaro Spallanzani, Rome, Italy Background: Despite the rising burden of advanced HIV disease (AHD) among persons with HIV (PWH) engaged in care in low-income countries, the dimension, features, and prognosis of this reclassified “neglected disease” in resource-rich settings have not been thoroughly evaluated. Methods: PWH enrolled in the Icona Foundation Study cohort with a first diagnosis of AHD (CD4<200cells/mm 3 or AIDS-defining event [ADE]) between January 1,2004 and December 31, 2023 were included. Participants were classified as having either a prevalent AHD ( pAHD : AHD diagnosed at the time of starting ART) or an incident AHD ( iAHD : AHD diagnosed >3 monthsafter starting ART) -the main exposure of interest. We also used an alternative 4-way exposure group to disentangle the effect of ADE. Temporal trends and demographic/clinical characteristics were described at the time of AHD

1132 Trends in Advanced HIV Disease Prevalence in 5 African Countries: An Analysis of Household Surveys Dominik Stelzle 1 , Ajay Rangaraj 1 , Joseph N. Jarvis 2 , George Perrin 3 , Nomthandazo Lukhele 4 , Sirak Hailu Bantiewalu 5 , Mugagga Kaggwa 6 , Mkhokheli Ngwenya 7 , Daniel Low-Beer 1 , Meg Doherty 1 , Nathan Ford 1 , Shona Dalal 1 1 World Health Organization, Geneva, Switzerland, 2 London School of Hygiene & Tropical Medicine, London, UK, 3 World Health Organization - Regional Office for Africa, Brazzaville, Repbulic of Congo, 4 World Health Organization Eswatini, Mbabane, Eswatini, 5 World Health Organization Lesotho, Maseru, Lesotho, 6 World Health Organization Uganda, Kampala, Uganda, 7 World Health Organization Zimbabwe, Harare, Zimbabwe Background: Advanced HIV disease (AHD) among adults is defined as a CD4 count <200 cells/mm³ or a World Health Organization HIV clinical stage 3 or 4. Data regarding trends in AHD prevalence in sub-Saharan Africa are limited. Methods: We analysed population-based HIV impact assessment (PHIA) household surveys from Eswatini, Lesotho, Malawi, Uganda and Zimbabwe, each of which had two surveys available between 2015 and 2021. The period between both rounds of PHIA in each country was around five years. We assessed changes in the proportion of adults living with HIV with a CD4 count <200 cells/mm³ (i.e. AHD prevalence), stratified by demographic factors and the HIV treatment cascade. Results: A total of 13,476 people living with HIV (PLHIV) were included in PHIA round 1 and 15,813 in PHIA round 2 across the five countries. During this period,

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