Twelve Steps to CD4 Testing

 

The 2016 and 2017 World Health Organization (WHO) guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the care of people living with HIV, and the use of antiretroviral (ARV) drugs for treating and preventing HIV infection. 

While these guidelines recommend lifelong antiretroviral therapy (ART) regardless of CD4 cell count (“treat all policy”) and analysis of viral load (VL) as the preferred monitoring approach, they also provide clear guidance on the indispensable role of CD4 in assessing baseline risk of disease progression— particularly for individuals presenting with advanced disease—decisions regarding starting and stopping prophylaxis for opportunistic infections (OIs), and prioritization decisions regarding ART initiation in settings where universal treatment is not possible. CD4 cell count measurement may also be important for people who are failing ART.
FLOWC-HIV CD4 Button Guidelines - Section 4
Two documents play a central role:

1. World Health Organization (2016): Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach – 2nd ed. http://www.who.int/hiv/pub/arv/arv-2016/en/ 

2. World Health Organization (2017): Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. http://www.who.int/hiv/pub/guidelines/advanced-HIV-disease/en/ 

In addition to the 2016 and 2017 guidelines, WHO published information notes that further define the role of CD4. 


3. World Health Organization (2017): What’s new in treatment monitoring: 
    Viral load and VCD4 testing. Information Note WHO/HIV/2017.22.
     http://www.who.int/hiv/pub/arv/treatment-monitoring-info-2017/en/ 



While these guidelines recommend lifelong ART regardless of CD4 cell count (“treat all policy”) and analysis of viral load (VL) as the preferred monitoring approach, they also provide clear guidance on the indispensable role of CD4 in the context of:

  1. Baseline testing
  2. Identification of advanced HIV disease
  3. Priorization of treatment initiation
  4. Rapid initiation of ART
  5. Treatment failure monitoring in the absence of VL testing
  6. Identification of immunological failure
  7. Prophylaxis interventions
  8. Management of opportunistic infections
  9. Vaccination schemes
  10. Adherence support
  11. Effective laboratory and diagnostic services

The role of CD4 in HIV analysis and patient management is defined by WHO guidelines. Beckman Coulter have condensed these guidelines into a short from pocket book Twelve Steps to CD4 Testing“  which is serialised in the page links. 

 

FREE Educational wall poster

outlining the new role of

CD4 in the WHO Guidelines

FLOWC Poster - Section 4

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Twelve Steps To CD4 Testing

WHO Guidelines CD4 Testing​

The 2016 and 2017 World Health Organization (WHO) guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the care of people living with HIV, and the use of antiretroviral (ARV) drugs for treating and preventing HIV infection.

12 Steps to CD4 Testing​ Part I: HIV Testing

The 2017 WHO guidelines point out that CD4 cell count testing at baseline for all people living with HIV remains important, because relying on clinical staging alone risks missing substantial numbers of people living with HIV with severe immune suppression.1 

12 Steps to CD4 Testing​ Part II: HIV Treatment

Recommendation for rapid initiation of ART People with no contraindication to rapid ART initiation should be fully informed of the benefits of ART and offered rapid ART initiation, including the option of  same-day initiation


12 Steps to CD4 Testing​ Part III: HIV & Opportunistic Infections

Co-trimoxazole prophylaxis is recommended for infants, children and adolescents with HIV, irrespective of clinical and immune conditions. Priority should be given to all children younger than 5 years old regardless of CD4 cell count or clinical stage.