Overview of advanced HIV disease care package
| Intervention | CD4 cell count | |
| Screening and diagnosis | CD4 cell count Four symptom screen, chest X-ray, C-reactive protein | Any |
| Molecular rapid diagnostic if TB screening positive* | Any | |
| LF-LAM screening | ≤200 cells/µL (inpatient)/≤100 cells/µL (outpatient)/ any if TB symptoms or seriously ill† | |
| CrAg screening | ≤100 cells/µL/considered if ≤200 cells/µL | |
| Prophylaxis/pre-emptive treatment | Co-trimoxazole prophylaxis | <350 cells/µL/ WHO stage 3 or 4/any if high prevalence of malaria or SBI |
| TB preventive treatment | Any | |
| Fluconazole pre-emptive therapy for CrAg-positive people without evidence of meningitis | ≤100 cells/µL | |
| ART initiation | Rapid ART initiation | Any |
| Defer initiation if clinical symptoms suggest meningitis (TB or cryptococcal) | Any | |
| Adherence support | Tailored counselling to support optimal adherence to the AHD care package, including home visits if feasible | CD4 <200 cells/µL |
Adapted from WHO.13
*WHO TB symptom screen includes presence of fever, weight loss or any cough. People living with HIV may present with signs or symptoms of extrapulmonary TB also including lymphadenopathy, meningitis or other atypical presentations warranting evaluation.
†Seriously ill is defined based on four danger signs: respiratory rate >30/min, temperature >39°C, heart rate >120/min and unable to walk unaided.
AHD, advanced HIV disease; ART, antiretroviral therapy; CrAg, cryptococcal antigen; LF-LAM, lateral flow lipoarabinomannan assay; SBI, severe bacterial infections (including bloodstream, respiratory, central nervous system and gastrointestinal infections); TB, tuberculosis; WHO, World Health Organization.