WHO Recommends CD4 Testing To Identify Advanced HIV Disease

CD4 tests are strongly recommended as the preferred method to identify advanced HIV disease among people living with HIV, the World Health Organization (WHO) has strongly recommended in its 2025 guidelines on advanced HIV disease.

A CD4 test is a blood examination that determines the level of CD4 T-lymphocytes, a crucial group of white blood cells responsible for orchestrating the body’s immune defences. Also known as T-helper cells, they signal and activate other immune cells to combat infections and disease.

In people living with HIV, the virus directly attacks and gradually depletes these cells, leading to progressive weakening of the immune system. Monitoring the CD4 count therefore provides doctors with a clear picture of immune function, helping them gauge disease severity and guide timely decisions on HIV treatment and care.

The WHO defines advanced HIV disease in adults, adolescents, and children five years and older, "as a CD4 cell count less than 200 cells/mm3".

"Advanced HIV disease is the major cause of AIDS-related deaths among people living with HIV. It is a serious public health issue, including in settings with good coverage of HIV testing and treatment, and despite having achieved or made good progress towards the 95–95–95 targets," the WHO said.

At the presentation, all children living with HIV younger than five years should be considered as having advanced HIV disease unless they have received ART for more than a year and are considered clinically stable.

“The 2025 guidelines respond to the need for better approaches to identify advanced HIV disease, improve the poor outcomes of people living with HIV being discharged from hospital,” the WHO said.

In the new guidelines, the WHO recommended CD4 testing for identifying advanced HIV disease.

However, “in settings in which CD4 testing is not yet available, WHO clinical staging can be used to identify advanced HIV disease,” the global health body said.

CD4 testing can be used to identify advanced HIV disease among people living with HIV who are: initiating or reinitiating ART; re-engaging in care following disengagement; have treatment failure or clinically identified treatment failure; and hospitalised, or seriously ill, or are considered clinically unstable.

The WHO noted that CD4 testing can also be used to support the identification of treatment failure when viral load testing is unavailable. CD4 testing can also help assess eligibility to stop co-trimoxazole prophylaxis and to assess eligibility for fluconazole prophylaxis.

The WHO noted that hospitalised people with HIV may be provided with interventions to support transitions to outpatient care and reduce avoidable readmissions.

The interventions may include: pre-discharge goal setting, medication review, transitional care planning, telephone follow-up, home visits by health-care providers and/or peer supporters, and individualised support.

The UN Healthy body also suggested paclitaxel or pegylated liposomal doxorubicin for pharmacological treatment for people living with HIV with Kaposi's sarcoma -- a rare type of cancer that forms in the lining of blood vessels and lymph vessels.

These guidelines also emphasised early detection, rapid ART initiation, and optimised clinical management to reduce morbidity and mortality.

“By implementing these recommendations, countries can reduce progression to severe illness and mortality, improve treatment outcomes, and advance global HIV elimination goals,” the WHO said.

According to a recent study results reported in Clinical Infectious Diseases, HIV-positive people who maintain or regain an adequate CD4 T-cell count on antiretroviral therapy are less likely to develop cancer, Those who do not experience good immune recovery, however, have a higher risk for cancer, underscoring the importance of prompt HIV treatment, says the study.