By Sharon Atieno

Advanced HIV disease (formerly known as AIDS) is still a threat in the African continent if action is not taken to increase access to treatment and diagnosis.

Health experts said during a two-day meeting held in Nairobi, Kenya to tackle issues related to diagnosing and treating advanced HIV disease (AHD) and find solutions that will enhance treatment accessibility, facilitate policy changes and improve the supply chain to end AIDS deaths.

According to the World Health Organization (WHO), an estimated two million people are living with HIV in sub-Saharan Africa. Of these more men than women have AHD despite fewer men having HIV overall.

A person with HIV is considered to have AHD if their CD4 count falls below 200 cells or they show symptoms of HIV clinical stages 3 or 4 which is characterized by tuberculosis, cryptococcal meningitis and severe bacterial infections.

A WHO study using Population-based HIV Impact Assessment (PHIA) survey data of 24, 621 people living with HIV from 12 sub-Saharan African countries found that 30% of people who were on antiretroviral therapy (ART) but were not virally suppressed were more likely to have AHD.

This was followed by those who were aware of their HIV status but not on ART (21%), people who were unaware of their HIV status (15%) and those on ART and virally suppressed (5%).

Dr. Rose Wafula, Kenya’s head of HIV treatment and prevention services

In Kenya, one in three persons living with HIV who are either new to treatment, with treatment failure or returning to care after interruption are presenting with AHD, according to Dr. Rose Wafula, the country’s head of HIV treatment and prevention services.

“It is therefore our collective responsibility as stakeholders to come together and urgently find solutions and practical ways to prevent, diagnose, treat and follow-up all patients with advanced HIV disease,” she said.

Dr Wafula notes that Kenya had 18,000 AIDS-related mortalities in 2022, the majority of whom were caused by TB and Cryptococcal meningitis. Despite advancements in access to ART, hundreds of thousands of people with advanced HIV die each year from Cryptococcal meningitis because affordable and accessible medicines to treat these infections are lacking.

According to Prof. Samuel Kariuki, Eastern Africa Director, Drugs for Neglected Diseases initiative (DNDi), AHD is a neglected disease due to inadequate research and tools to prevent, screen, diagnose and treat it.

“While HIV has received a lot of attention over the years, advanced HIV suffers from limited attention paid to either innovating on existing tools or finding new tools for preventing AIDS-related deaths,” he said.

DnDi and its partners are working on reformulating the current flucytosine treatment into a sustained-release formulation to help patients adhere to treatment and simplify healthcare workers’ care.

Dr. Medhin Tsehaiu, Kenya’s UNAIDS country director, emphasized opportunities to reduce AIDS-related health disparities. These include ending all forms of discrimination, empowering communities to take the lead in the response, and integrating HIV and other health services, such as screening for non-communicable diseases and mental health.

The meeting was convened by the AHD alliance, which comprises DNDi, End AIDS Action Group, Fight AIDS Coalition, Infectious Diseases Institute, Makerere University, Uganda, Médecins Sans Frontières (MSF), Partners in Hope, and St. George’s, University of London.

The meeting also covered topics including community-level progress and challenges, roundtable discussions on the CD4 landscape, advanced HIV disease in children, non-communicable diseases and AHD. It also addressed the latest developments, initiatives, and bottlenecks among key AHD donors, country-level supply chain challenges and solutions, and new tools and technologies in AHD diagnostics and therapeutics.