HIV Advanced Disease  Management

More than a third of people starting ART have advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following disengagement from care. The leading causes of morbidity and mortality in these patients include tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia. In 2017, WHO published guidelines for the management of advanced HIV disease in adults, adolescents, and children and recommended a package of care that includes opportunistic infection screening and prophylaxis, depending on age and CD4 cell count. Advanced HIV disease has been until recently largely neglected and remains a persistent problem, particularly in low-income and middle-income countries.