Advanced HIV disease and epidemic control in sub-Saharan Africa

Antiretroviral treatment (ART) scale-up under the treat-all strategy has been the cornerstone of the global response to the HIV epidemic since 2015. Despite the subsequent increase in HIV treatment global coverage, reductions in AIDS-related mortality have lagged, likely because of advanced HIV disease (AHD).1 AHD, defined as a CD4 count of less than 200 cells per mm3 or WHO stage of 3 or 4 in people living with HIV age 5 years or older,2 has affected a persistent 30% of those initiating ART in clinical programmes since 2015, despite the ART scale-up.