Prevalence and associated factors of advanced HIV disease among ART-naïve and ART-experienced people with HIV at AHF-supported sites in Zambia

BackgroundIndividuals with advanced HIV disease (AHD) have a heightened risk of mortality despite access to antiretroviral therapy (ART). Sub-Saharan Africa (SSA) has a disproportionate burden of AHD-associated deaths. However, there is limited country-specific data on AHDs burden and associated risk factors to help design targeted interventions. Therefore, this study determined the prevalence and factors associated with AHD among ART-naive and ART-experienced adults with HIV at five AIDS Healthcare Foundation (AHF)-supported facilities in Zambia. MethodologyWe conducted a cross-sectional study among 231 ART-naive and ART-experienced people living with HIV (PLHIV) and collected demographic and clinical data using a structured questionnaire. The primary outcome was AHD, defined as a CD4 count less than 200 cells/{micro}L using the VISITECT(R) CD4 point-of-care test. Multivariable logistic regression was used to assess factors associated with AHD. ResultsAmong the study participants, 59.7% were female, and 54% were aged 19-35 years. Most participants were ART-naive (79.2%), with 85.3% classified in WHO clinical stage 1. The prevalence of AHD was 47.6% (110/231), significantly higher among ART-naive participants [51.9% (95/183)] compared to ART-experienced participants [31.2% (15/48), p=0.011]. ART-naive participants aged 19-35 years exhibited a notably higher prevalence of AHD (51.6%) compared to those aged 13-18, 36-45, and >45 years (5.3%, 34.7%, and 8.4%, respectively) and had significantly higher baseline viral load values (25,000 copies/mL vs. 9,690 copies/mL, p=0.037). Additionally, among ART-naive participants, a significantly higher proportion of individuals in WHO stages 2, 3, and 4 had AHD compared to those without AHD. Across all participants, the factors significantly associated with AHD included anemia (adjusted odds ratio [aOR] 3.03, 95% confidence interval [CI]: 1.15-7.97) and being from the New Masala Clinic health facility (aOR 3.79, 95% CI: 1.17-12.30) ConclusionAdvanced HIV disease was prevalent, particularly among ART-naive individuals, and it was significantly associated with anemia and health facility location. There is a need for formulation of interventions, especially among ART-naive PLHIV who are anemic. Additionally, studies to integrate point-of-care diagnostics such as the VISITECT(R) CD4 test into routine HIV care be conducted in resource-limited settings are warranted for early detection of AHD.