Modern ART Uptake Has Made CD4 Testing Low Priority

HIV stethoscope © grandeduc - stock.adobe.com

For many years, HIV treatment was only given to people with a low CD4 count and therefore at the highest risk for death. However, two 2015 trials suggested every patient should be started on treatment immediately after diagnosis. This led to the impression that CD4 testing is no longer essential, and funding was pulled away from CD4 testing and put toward broader treatment coverage, according to an article posted Feb. 3 in the New England Journal of Medicine.

The article, written by Nathan Ford, D.Sc., Peter Ehrenkranz, M.D., and Joseph Jarvis, M.B., B.S., reports that as HIV treatment becomes more accessible to everyone, those in the advanced stages of the disease have started to fall through the cracks.

Advanced HIV is defined as a CD4 count of less than 200 cells per cubic millimeter. An estimated 4 million people have advanced HIV, with 600,000 expected to die each year. Most cases today are patients who initially received treatment but fell off and returned only when ill. Once the disease becomes advanced, there is little that can be done.

Trial data has shown a noticeable drop in CD4 cells within the first two months of stopping treatment. Testing has never left the clinical guidelines of the World Health Organization.

“Overall, HIV is not a ne­glected disease — tens of billions of dollars have been invested in scaling up access to prevention and treatment. In the past decade, however, advanced HIV has be­ come neglected, with limited at­tention paid to either consistently using existing tools or finding new tools for preventing AIDS­ related deaths,” the authors write.