Details:

Alternative Title:
AIDS Res Ther
Personal Author:
Boyd, Andrew T. ; Oboho, Ikwo ; Paulin, Heather ; Ali, Hammad ; Godfrey, Catherine ; ... More +
Boyd, Andrew T. ; Oboho, Ikwo ; Paulin, Heather ; Ali, Hammad ; Godfrey, Catherine ; Date, Anand ; Sean Cavanaugh, J. Less -
Description:
Introduction

The US President’s Emergency Plan for AIDS Relief (PEPFAR) was launched to increase access to antiretroviral treatment (ART) among people living with HIV (PLHIV) and to prevent new HIV infections globally. As new infections have decreased in many PEPFAR-supported countries, PEPFAR is increasingly focusing on understanding and decreasing mortality among PLHIV, specifically by addressing advanced HIV disease (AHD) and its attendant opportunistic infections (OIs). Several developments in identifying AHD, in preventing, diagnosing, and treating selected OIs, and in PEPFAR’s support for mortality surveillance make this an opportune moment for PEPFAR to address HIV-related mortality.

Discussion

AHD upon diagnosis or re-engagement in HIV care is not uncommon, and it substantially increases risk of death from OIs. The World Health Organization provides evidence-based guidelines for a package of interventions for preventing, diagnosing, and treating common OIs, including tuberculosis (TB), cryptococcal meningitis, and severe bacterial infections. PEPFAR facilitates implementation of these guidelines. To identify PLHIV with low CD4, PEPFAR plans to support expanded access to CD4 testing, including a point-of-care assay that differentiates CD4 cell count as a binary of greater than or less than 200 cells/µL. To prevent AHD-related mortality, PEPFAR supports rapid ART initiation with integrase inhibitor–based regimens and implementation and documentation of TB preventive treatment. To diagnose selected OIs, PEPFAR is implementing urine lateral flow lipoarabinomannan use to identify TB among PLHIV who have a CD4 cell count < 200 cells/µL. To treat selected OIs, PEPFAR has focused on improving patient-centered care in TB/HIV co-infection services and scaling up implementation of new drug regimens for cryptococcal meningitis. To better understand mortality, PEPFAR has introduced an indicator, TX_ML, to routinely and systematically categorize outcomes, including deaths, among PLHIV on ART.

Conclusions

PEPFAR is increasing its efforts to identify AHD; to prevent, diagnose, and treat OIs; and to track mortality in its programs. These ongoing efforts, done in collaboration with other stakeholders, seek to decrease mortality among PLHIV.


Subjects:
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Advanced HIV Disease HIV Mortality Opportunistic Infections PEPFAR Review Tuberculosis
Source:
AIDS Res Ther. 17
Pubmed ID:
32650797
Pubmed Central ID:
PMC7348123
Document Type:
Journal Article
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:978eb8d68a77be1f89d136e0b0bbf5f0b4f9c11290f5a64a3cbc2ee76e214770
Download URL:
https://stacks.cdc.gov/view/cdc/93285/cdc_93285_DS1.pdf
File Type:

Supporting Files

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