Global prevalence of advanced HIV disease in healthcare settings: a rapid review

IF 4.6 1区 医学 Q2 IMMUNOLOGY
Nathan Ford, Reshma Kassanjee, Dominik Stelzle, Joseph N Jarvis, Omar Sued, Georges Perrin, Meg Doherty, Ajay Rangaraj
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引用次数: 0

Abstract

Introduction

Recent studies have indicated a high enduring burden of advanced HIV disease, but estimates across regions and settings are lacking. The aim of this study was to estimate the prevalence of advanced HIV disease since 2015 among those people with CD4 measured in healthcare settings, disaggregated by age group, level of healthcare and region.

Methods

We searched MedLine via Pubmed and Hinari for studies that reported the proportion of individuals with advanced HIV disease (defined as CD4 cell count <200 cells/mm3) in healthcare settings since 2015; this search was complemented by conference abstracts and data from the International epidemiology Databases to Evaluate AIDS Consortium (IeDEA). We estimated pooled prevalence of advanced HIV disease using random-effects models and performed subgroup and sensitivity analyses to explore heterogeneity.

Results

We obtained data from 117 cohorts, representing 1,814,362 individuals from 52 countries across all six World Health Organization regions. The majority of studies (n = 83) were conducted among adults and recorded CD4 cell count among treatment naïve individuals at antiretroviral therapy start (n = 86). Studies included data reported up to 2023. The proportion of individuals with advanced HIV disease was higher in inpatient settings (44.3%, 95% CI 39.1−49.6%) compared to outpatient settings (33.5%, 95% CI 31.5−35.4%). Prevalence was similar across age groups, time since HIV diagnosis and treatment status, and highest in West and Central Africa, South-East Asia and the Eastern Mediterranean region.

Discussion

This review finds that at least a third of people presenting to healthcare settings have advanced HIV disease, with no evidence that this has changed in recent years. Screening for advanced HIV remains important to be able to direct appropriate preventive, diagnostic and therapeutic interventions to prevent progression to severe illness and death.

Conclusions

This review summarizes recent evidence of the continued high proportion of individuals who (re)present to care with advanced HIV disease. These findings underscore the urgent need to reinforce programme capacity to diagnose, prevent and treat advanced HIV disease as an essential pillar of the global AIDS response.

Abstract Image

全球艾滋病毒晚期疾病在卫生保健机构的流行:快速审查
最近的研究表明,晚期艾滋病毒疾病的长期负担很高,但缺乏跨区域和环境的估计。本研究的目的是估计自2015年以来在医疗机构测量CD4的人群中晚期艾滋病毒疾病的患病率,按年龄组、医疗保健水平和地区分类。方法:我们通过Pubmed和Hinari检索MedLine,检索自2015年以来报告医疗机构中晚期HIV疾病个体比例(定义为CD4细胞计数<;200细胞/mm3)的研究;这项研究得到了会议摘要和来自国际艾滋病流行病学数据库评估联盟(IeDEA)的数据的补充。我们使用随机效应模型估计晚期HIV疾病的总流行率,并进行亚组和敏感性分析以探索异质性。我们获得了来自117个队列的数据,代表了来自世界卫生组织所有六个区域52个国家的1,814,362人。大多数研究(n = 83)是在成人中进行的,并记录了抗逆转录病毒治疗开始时naïve患者的CD4细胞计数(n = 86)。研究包括截至2023年的数据。与门诊(33.5%,95% CI 31.5 - 35.4%)相比,住院环境中患有晚期HIV疾病的个体比例(44.3%,95% CI 39.1 - 49.6%)更高。各年龄组、自艾滋病毒诊断和治疗以来的时间流行率相似,西非和中非、东南亚和东地中海区域的流行率最高。本综述发现,到医疗机构就诊的人中至少有三分之一患有晚期艾滋病毒疾病,没有证据表明近年来这种情况发生了变化。对晚期艾滋病毒进行筛查仍然很重要,以便能够指导适当的预防、诊断和治疗干预措施,防止发展为严重疾病和死亡。结论:本综述总结了最近的证据,表明晚期艾滋病患者(再)接受治疗的个体比例仍然很高。这些调查结果突出表明,迫切需要加强方案诊断、预防和治疗艾滋病毒晚期疾病的能力,作为全球艾滋病防治工作的一个重要支柱。
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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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