Prevalence and trends of advanced HIV disease among antiretroviral therapy-naïve and antiretroviral therapy-experienced patients in South Africa between 2010-2021: a systematic review and meta-analysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968551 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2334 (Electronic) Linking ISSN: 14712334 NLM ISO Abbreviation: BMC Infect Dis Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

HIV* ; HIV Infections*/drug therapy ; HIV Infections*/epidemiology; Humans ; South Africa/epidemiology ; Prevalence ; CD4 Lymphocyte Count

Background: Despite the significant progress made in South Africa in getting millions of individuals living with HIV into care, many patients still present or re-enter care with Advanced HIV Disease (AHD). We aimed to estimate the prevalence of AHD among ART-naive and ART-experienced patients in South Africa using studies published between January 2010 and May 2022.
Methods: We searched for relevant data on PubMed, CINAHL, Scopus and other sources, with a geographical filters limited to South Africa, up to May 31, 2022. Two reviewers conducted all screening, eligibility assessment, data extraction, and critical appraisal. We synthesized the data using the inverse-variance heterogeneity model and Freeman-Tukey transformation. We assessed heterogeneity using the I ² statistic and publication bias using the Egger and Begg's test.
Results: We identified 2,496 records, of which 53 met the eligibility criteria, involving 11,545,460 individuals. The pooled prevalence of AHD among ART-naive and ART-experienced patients was 43.45% (95% CI 40.1-46.8%, n = 53 studies) and 58.6% (95% CI 55.7 to 61.5%, n = 2) respectively. The time trend analysis showed a decline of 2% in the prevalence of AHD among ART-naive patients per year. However, given the high heterogeneity between studies, the pooled prevalence should be interpreted with caution.
Conclusion: Despite HIV's evolution to a chronic disease, our findings show that the burden of AHD remains high among both ART-naive and ART-experienced patients in South Africa. This emphasizes the importance of regular measurement of CD4 cell count as an essential component of HIV care. In addition, providing innovative adherence support and interventions to retain ART patients in effective care is a crucial priority for those on ART.
(© 2023. BioMed Central Ltd., part of Springer Nature.)

Int J Tuberc Lung Dis. 2013 Sep;17(9):1199-205. (PMID: 23928169)
Clin Infect Dis. 2018 Oct 15;67(9):1411-1418. (PMID: 29659757)
PLoS One. 2015 Apr 09;10(4):e0121843. (PMID: 25856495)
BMJ. 1997 Nov 22;315(7119):1371-4. (PMID: 9432250)
Arch Public Health. 2014 Nov 10;72(1):39. (PMID: 25810908)
Trop Med Int Health. 2015 Apr;20(4):518-26. (PMID: 25442109)
PLoS One. 2022 Mar 24;17(3):e0265488. (PMID: 35324923)
AIDS Behav. 2023 Jan;27(1):358-369. (PMID: 35908271)
Clin Infect Dis. 2018 Mar 4;66(suppl_2):S111-S117. (PMID: 29514238)
S Afr Med J. 2020 May 29;110(6):505-513. (PMID: 32880563)
Pan Afr Med J. 2014 Oct 01;19:114. (PMID: 25722787)
Clin Infect Dis. 2018 Mar 4;66(suppl_2):S118-S125. (PMID: 29514233)
Medicine (Baltimore). 2015 Dec;94(50):e2269. (PMID: 26683950)
Clin Infect Dis. 2014 May;58(10):1467-72. (PMID: 24567248)
Contemp Clin Trials. 2007 Feb;28(2):105-14. (PMID: 16807131)
Biometrics. 1994 Dec;50(4):1088-101. (PMID: 7786990)
BMJ. 2021 Mar 29;372:n71. (PMID: 33782057)
J Acquir Immune Defic Syndr. 2012 Mar 1;59(3):e28-34. (PMID: 22173039)
Int J STD AIDS. 2018 Nov;29(11):1048-1056. (PMID: 29749876)
AIDS Care. 2016;28(1):32-42. (PMID: 26273853)
Am J Respir Crit Care Med. 2011 Jul 1;184(1):132-40. (PMID: 21493734)
AIDS Behav. 2019 Feb;23(2):375-385. (PMID: 30008050)
J Clin Epidemiol. 2012 Sep;65(9):934-9. (PMID: 22742910)
EClinicalMedicine. 2021 Jul 07;38:100991. (PMID: 34278282)
PLoS One. 2020 Jan 14;15(1):e0227572. (PMID: 31935240)
Clin Infect Dis. 2015 Apr 1;60(7):1120-7. (PMID: 25516189)
Thorax. 2011 Aug;66(8):669-73. (PMID: 21632522)
Lancet HIV. 2020 Jul;7(7):e514-e520. (PMID: 32473102)
J Int AIDS Soc. 2020 Jul;23(7):e25546. (PMID: 32640106)
J Int AIDS Soc. 2017 Nov;20(3):. (PMID: 29178578)
PLoS Med. 2021 May 24;18(5):e1003651. (PMID: 34029346)
Glob Health Action. 2019;12(1):1679472. (PMID: 31679482)
S Afr Med J. 2017 Nov 27;107(12):1058-1064. (PMID: 29262956)
Lancet Glob Health. 2020 Oct;8(10):e1326-e1334. (PMID: 32971055)
Bull World Health Organ. 2010 Sep 1;88(9):675-80. (PMID: 20865072)
MMWR Morb Mortal Wkly Rep. 2017 Jun 02;66(21):558-563. (PMID: 28570507)
JAMA Netw Open. 2021 Jan 4;4(1):e2031190. (PMID: 33449093)
PLoS One. 2010 Dec 22;5(12):e15664. (PMID: 21203513)
PLOS Glob Public Health. 2022 Dec 14;2(12):e0000336. (PMID: 36962695)
AIDS Res Hum Retroviruses. 2020 Apr;36(4):297-299. (PMID: 31663368)
BMC Health Serv Res. 2018 Feb 27;18(1):140. (PMID: 29482587)
J Antimicrob Chemother. 2017 Nov 01;72(11):3141-3148. (PMID: 28981637)
Sex Transm Infect. 2014 Dec;90(8):615-9. (PMID: 24837992)
PLoS One. 2018 Apr 19;13(4):e0195127. (PMID: 29672542)
Mycoses. 2020 May;63(5):478-487. (PMID: 32125004)
J Acquir Immune Defic Syndr. 2014 Apr 1;65(4):438-46. (PMID: 24256629)
J Int AIDS Soc. 2022 Jan;25(1):e25870. (PMID: 35032096)
PLoS One. 2015 Jul 21;10(7):e0133452. (PMID: 26196688)
J Int AIDS Soc. 2021 Oct;24 Suppl 6:e25802. (PMID: 34713545)
BMC Infect Dis. 2019 Mar 15;19(1):261. (PMID: 30876400)
PLoS Med. 2011 Jul;8(7):e1001067. (PMID: 21818180)
AIDS. 2023 Mar 1;37(3):513-522. (PMID: 36695361)
Medicine (Baltimore). 2019 Feb;98(8):e14664. (PMID: 30813211)
AIDS Behav. 2017 Jun;21(6):1632-1640. (PMID: 27251436)
PLoS One. 2013;8(1):e55305. (PMID: 23383147)
PLoS One. 2019 May 31;14(5):e0217742. (PMID: 31150489)
AIDS. 2013 Feb 20;27(4):645-50. (PMID: 23169326)
Infect Agent Cancer. 2011 Nov 17;6:22. (PMID: 22093140)
Clin Infect Dis. 2018 Mar 5;66(6):893-903. (PMID: 29373672)
HIV Med. 2012 Feb;13(2):132-7. (PMID: 22103326)
Clin Infect Dis. 2013 Oct;57(7):1027-37. (PMID: 23921882)
J Acquir Immune Defic Syndr. 2011 Apr;56(4):349-55. (PMID: 20926954)
PLoS One. 2012;7(7):e39966. (PMID: 22815718)
AIDS Behav. 2019 Jun;23(6):1656-1667. (PMID: 30560484)
PLoS One. 2012;7(11):e40623. (PMID: 23152745)
PLoS Med. 2014 Sep 09;11(9):e1001718. (PMID: 25203931)
Lancet. 2010 Aug 7;376(9739):449-57. (PMID: 20638120)

Keywords: ART-experienced; ART-naïve; Advanced HIV disease; Burden; South Africa

Date Created: 20230823 Date Completed: 20230824 Latest Revision: 20231121

20231121

PMC10464046

10.1186/s12879-023-08521-4

37608300