{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:44:07Z","timestamp":1772988247279,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Discontinuation of antiretroviral therapy (ART) significantly contributes to the development of advanced HIV disease (AHD) and opportunistic infections. This study analyzed data from patients who re\u2010engaged in care after ART interruption and compared the cohort with patients with newly diagnosed HIV, focusing on the burden of tuberculosis and histoplasmosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A diagnostic package for opportunistic infections was implemented in Guatemala in 2017, encompassing tuberculosis and histoplasmosis. From 2017 to 2019, we enrolled 1379 adults re\u2010engaging in care and 3412 patients with newly diagnosed HIV across 13 healthcare facilities. Data collection included demographic information, laboratory test results, and patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among patients re\u2010engaging in care, 54% (491 of 903) had AHD, which was comparable to the 50.1% (1349 of 2692) in newly diagnosed patients. Among the re\u2010engaging cohort, 34.5% had not undergone CD4 testing, compared with 21.1% in the newly diagnosed group. This highlights a significant gap in assessing advanced HIV status through an objective, unbiased test. Among patients re\u2010engaging in care, the incidence rates of tuberculosis and histoplasmosis were 9.7% and 8.3%, respectively, regardless of immune status. This indicated a high burden of opportunistic infections in this group, with newly diagnosed patients showing similar incidence rates of 8.5% for tuberculosis and 8.3% for histoplasmosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients re\u2010engaging in care should follow a similar process to newly diagnosed patients. There is an urgent need for routine and immediate CD4 testing to identify AHD and implement the recommended comprehensive diagnostic and care package. Early detection and targeted interventions are crucial for reducing AIDS\u2010related mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hiv.70000","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T23:19:26Z","timestamp":1739834366000},"page":"701-708","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patients re\u2010engaging with\n                    <scp>HIV<\/scp>\n                    care in Guatemala: Prioritizing\n                    <scp>CD4<\/scp>\n                    counting and screening for histoplasmosis and tuberculosis"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6176-0052","authenticated-orcid":false,"given":"Narda","family":"Medina","sequence":"first","affiliation":[{"name":"Asociaci\u00f3n de Salud Integral  Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Alastruey\u2010Izquierdo","sequence":"additional","affiliation":[{"name":"Global Action for Fungal Infections  Geneva Switzerland"},{"name":"Mycology Reference Laboratory, National Centre for Microbiology Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Bonilla","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Familiar \u201cLuis Angel Garc\u00eda\u201d\/Hospital General San Juan de Dios  Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danicela","family":"Mercado","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Familiar \u201cLuis Angel Garc\u00eda\u201d\/Hospital General San Juan de Dios  Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Arathoon","sequence":"additional","affiliation":[{"name":"Asociaci\u00f3n de Salud Integral  Guatemala City Guatemala"},{"name":"Cl\u00ednica Familiar \u201cLuis Angel Garc\u00eda\u201d\/Hospital General San Juan de Dios  Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Luis","family":"Rodriguez\u2010Tudela","sequence":"additional","affiliation":[{"name":"Global Action for Fungal Infections  Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"World Health Organization (WHO).HIV statistics globally and by WHO Region.2023."},{"key":"e_1_2_10_3_1","unstructured":"World Health Organization.Consolidated guidelines on HIV prevention testing treatment service delivery and monitoring: Recommendations for a public health approach."},{"key":"e_1_2_10_4_1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS).Global HIV report.2023."},{"key":"e_1_2_10_5_1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS).Global HIV report.2022."},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2011.02828.x"},{"key":"e_1_2_10_7_1","unstructured":"ReidSE MulengaLB FolkWR TambatambaBC ChiBH.Abandonment of antiretroviral therapy: A potential barrier to scale\u2010up in Sub\u2010Saharan Africa.2012."},{"key":"e_1_2_10_8_1","unstructured":"World Health Organization (WHO).Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral theraphy.2017."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw125"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473\u20103099(18)30354\u20102"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms9122596"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002631"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jof7040268"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0226987"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy045"},{"key":"e_1_2_10_16_1","unstructured":"The Joint United Nations Programme on HIV\/AIDS UNAIDS data 2021 report. 2022 1\u2013468."},{"key":"e_1_2_10_17_1","unstructured":"Programa Nacional de Prevenci\u00f3n y Control de ITS VIH y SIDA P.Informe Nacional de La Cascada Del Continuo de Atenci\u00f3n En VIH. 2018 24 13\u201335."},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1086\/342603"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002554"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1960.9.518"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473\u20103099(17)30303\u20101"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1008449"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12281\u2010011\u20100081\u20107"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0059373"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001861"},{"key":"e_1_2_10_26_1","unstructured":"Wolrd Health Organization (WHO); World Health Organization (WHO).Lateral Flow Urine Lipoarabinomannan Assay (LF\u2010LAM) for the diagnosis of active tuberculosis in people living with 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