Abstract
In an Essay, Mark Tenforde and colleagues advocate continued provision of baseline CD4 cell count testing in HIV care in low- and middle-income countries.
Highlights
Considerable progress has been made, a significant proportion of patients starting Antiretroviral therapy (ART) in low- and middleincome country (LMIC) continue to present with severe immunosuppression, with recent laboratory-based surveillance showing that one-third of South African patients still enter care with advanced HIV infection (CD4 < 200 cells/μL) [7,8]
Baseline CD4 is an essential part of HIV care, and implementation research is needed to better streamline this and other new point-of-care tests for opportunistic infection (OI) to make them practical to perform in underresourced centers
We present a resource-based public health approach according to diagnostic test availability that could decrease early mortality after ART initiation and would be practical to implement
Summary
Considerable progress has been made, a significant proportion of patients starting ART in LMICs continue to present with severe immunosuppression, with recent laboratory-based surveillance showing that one-third of South African patients still enter care with advanced HIV infection (CD4 < 200 cells/μL) [7,8]. These late presenters have the highest risk for death, unmasking of opportunistic infections (OIs), and immune reconstitution inflammatory syndrome.
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