Daijiworld Media Network - New Delhi
New Delhi, Dec 23: The World Health Organization (WHO) has strongly recommended CD4 testing as the preferred method for identifying advanced HIV disease among people living with HIV, as part of its newly released 2025 guidelines.
According to the WHO, advanced HIV disease in adults, adolescents and children aged five years and above is defined by a CD4 cell count of fewer than 200 cells per cubic millimetre. The UN health agency stressed that advanced HIV disease remains the leading cause of AIDS-related deaths globally, even in regions with widespread access to HIV testing and treatment and in countries nearing the 95–95–95 targets.
For children under five years of age, the WHO said all HIV-positive cases should be considered as advanced disease unless the child has been on antiretroviral therapy (ART) for more than a year and is clinically stable.
The updated guidelines aim to improve early identification of advanced HIV disease and address poor health outcomes, particularly among people being discharged from hospitals. The WHO noted that better diagnostic strategies are critical to reducing preventable illness and deaths.
Under the new recommendations, CD4 testing should be used to identify advanced HIV disease in people who are starting or restarting ART, returning to care after a treatment gap, experiencing treatment failure, or those who are hospitalised, seriously ill or clinically unstable. In settings where CD4 testing is not yet available, WHO clinical staging may be used as an alternative.
The organisation also highlighted the continued importance of CD4 testing in cases where viral load testing is unavailable, as it can help indicate treatment failure. Additionally, CD4 results can guide decisions on stopping co-trimoxazole prophylaxis and determining eligibility for fluconazole prophylaxis.
For hospitalised people living with HIV, the WHO advised the use of structured interventions to support safe transition to outpatient care and reduce avoidable readmissions. These may include pre-discharge planning, medication reviews, follow-up calls, home visits by healthcare workers or peer supporters, and tailored patient support.
The guidelines also address the management of HIV-associated Kaposi’s sarcoma, recommending paclitaxel or pegylated liposomal doxorubicin as treatment options.
Emphasising early diagnosis, rapid initiation of ART and improved clinical care, the WHO said implementation of these recommendations could significantly reduce severe illness and mortality while strengthening global efforts toward HIV elimination.