{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:13:30Z","timestamp":1781007210243,"version":"3.54.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T00:00:00Z","timestamp":1696982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>For adults and adolescents, the World Health Organization defines advanced HIV disease (AHD) as a CD4 (cluster of differentiation 4) count of &lt;200 cells\/mm<jats:sup>3<\/jats:sup> or a clinical stage 3 or 4 event. We describe clinical outcomes in a cohort of AHD patients at two regional hospitals in Lesotho. From November 2018\u2013June 2019, we prospectively enrolled eligible patients (\u226515 years) not on antiretroviral therapy (ART) presenting with WHO-defined AHD into a differentiated model of care for AHD (including rapid ART initiation) and followed them for six months. All patients received Tuberculosis (TB) symptom screening with further diagnostic testing; serum cryptococcal antigen (CrAg) screening was done for CD4 <jats:underline>&lt;<\/jats:underline>100 cells\/mm<jats:sup>3<\/jats:sup> or WHO clinical stage 3 or 4. Medical record data were abstracted using visit checklist forms. Categorical and continuous variables were summarized using frequencies, percentages, and means, respectively. Kaplan-Meier was used to estimate survival. Of 537 HIV-positive patients screened, 150 (27.9%) had AHD of which 109 were enrolled. Mean age was 38 years and 62 (56.9%) were men. At initial clinic visit, 8 (7.3%) were already on treatment and 33% (36\/109) had presumptive TB per symptom screening. Among 39\/109 (40.2%) patients screened for CrAg at initial visit, five (12.8%) were CrAg-positive. Among 109 enrolled, 77 (70.6%) initiated ART at their initial clinic visit, while 32 delayed ART initiation (median delay: 14 days). Of the 109 participants enrolled, 76 (69.7%) completed the 6-month follow-up, 17 (15.6%) were lost to follow-up, 5 (4.6%) transferred to other health facilities and 11 (10.1%) died. The 6-month survival was 87.4%; among 74 patients with a viral load result, 6-month viral suppression (&lt;1,000 copies\/ml) was 85.1%. Our study found that even after the implementation of Test and Treat of ART in 2016 in Lesotho, over 25% of patients screened had AHD. Patients with AHD had a high prevalence of TB and CrAg positivity, underscoring the need to assess for AHD and rapidly initiate ART within a package of AHD care for optimal patient outcomes.<\/jats:p>","DOI":"10.1371\/journal.pone.0292660","type":"journal-article","created":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T17:37:16Z","timestamp":1697045836000},"page":"e0292660","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Rapid antiretroviral therapy initiation in patients with advanced HIV disease: 6-month outcomes of an observational cohort evaluation in Lesotho"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8045-7590","authenticated-orcid":true,"given":"Appolinaire","family":"Tiam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2024-0939","authenticated-orcid":true,"given":"Heather","family":"Paulin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhoderick","family":"Machekano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikwo","family":"Oboho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elfriede","family":"Agyemang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred Asiimwe","family":"Mugyenyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Llang","family":"Maama-Maime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohannes","family":"Mengistu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1232-4769","authenticated-orcid":true,"given":"Tsitsi","family":"Chatora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"More","family":"Mungati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majoalane","family":"Mokone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsietso","family":"Mots\u2019oane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annah","family":"Masheane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Tukei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,11]]},"reference":[{"key":"pone.0292660.ref001","volume-title":"Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017","author":"World Health Organization","year":"2017"},{"issue":"1","key":"pone.0292660.ref002","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/QAI.0b013e318288b39d","article-title":"Immune recovery after starting ART in HIV-infected patients presenting and not presenting with tuberculosis in South Africa","volume":"63","author":"M Schomaker","year":"2013","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"issue":"1","key":"pone.0292660.ref003","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/imr.12064","article-title":"Immune restoration after antiretroviral therapy: the pitfalls of hasty or incomplete repairs","volume":"254","author":"EMP Wilson","year":"2013","journal-title":"Immunological Reviews"},{"issue":"3","key":"pone.0292660.ref004","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/cid\/cir802","article-title":"Paradoxical immune reconstitution inflammatory syndrome in HIV-infected patients treated with combination antiretroviral therapy after AIDS-defining opportunistic infection. Clinical infectious diseases: an official publication of the","volume":"54","author":"CJ Achenbach","year":"2012","journal-title":"Infectious Diseases Society of America"},{"key":"pone.0292660.ref005","unstructured":"Government of Lesotho MoH. National Guidelines on the Use of Antiretroviral Therapy for HIV Prevention and Treatment, Fifth Edition. Maseru, Lesotho: Lesotho Ministry of Health; 2016."},{"key":"pone.0292660.ref006","doi-asserted-by":"crossref","unstructured":"The TEMPRANO ANRS 12136 Study Group. A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa. New England Journal of Medicine. 2015;373(9):808\u201322.","DOI":"10.1056\/NEJMoa1507198"},{"key":"pone.0292660.ref007","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1097\/QAI.0000000000000209","article-title":"Preventing Tuberculosis Among HIV-Infected Pregnant Women in Lesotho: The Case for Rolling Out Active Case Finding and Isoniazid Preventive Therapy","volume":"67","author":"A Tiam","year":"2014","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"issue":"9983","key":"pone.0292660.ref008","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1016\/S0140-6736(15)60164-7","article-title":"Cryptococcal meningitis screening and community-based early adherence support in people with advanced HIV infection starting antiretroviral therapy in Tanzania and Zambia: an open-label, randomised controlled trial","volume":"385","author":"S Mfinanga","year":"2015","journal-title":"Lancet (London, England)"},{"issue":"3","key":"pone.0292660.ref009","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1056\/NEJMoa1615822","article-title":"Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa","volume":"377","author":"J Hakim","year":"2017","journal-title":"The New England journal of medicine"},{"issue":"1","key":"pone.0292660.ref010","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1353\/hpu.2013.0014","article-title":"The problem of late ART initiation in Sub-Saharan Africa: a transient aspect of scale-up or a long-term phenomenon?","volume":"24","author":"M Lahuerta","year":"2013","journal-title":"Journal of health care for the poor and underserved"},{"issue":"3","key":"pone.0292660.ref011","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s11904-013-0165-9","article-title":"Asymptomatic cryptococcemia in resource-limited settings","volume":"10","author":"AC Meyer","year":"2013","journal-title":"Current HIV\/AIDS reports"},{"issue":"4","key":"pone.0292660.ref012","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/tmi.12067","article-title":"The impact of routine cryptococcal antigen screening on survival among HIV-infected individuals with advanced immunosuppression in Kenya","volume":"18","author":"A-CL Meyer","year":"2013","journal-title":"Tropical Medicine & International Health"},{"key":"pone.0292660.ref013","volume-title":"Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection","author":"World Health Organization","year":"2018"},{"issue":"9","key":"pone.0292660.ref014","first-page":"2500","article-title":"The Enduring Burden of Advanced Human Immunodeficiency Virus Disease","volume":"71","author":"N Ford","year":"2020","journal-title":"Clinical Infectious Diseases"},{"key":"pone.0292660.ref015","unstructured":"Joint United Nations Programme on HIV\/AIDS 2021. UNAIDS Data 2021. Joint United Nations Programme on HIV\/AIDS; 2021."},{"key":"pone.0292660.ref016","unstructured":"Government of Lesotho MoH. National Strategy and Implementation Plan for Scaling Up HIV Viral Load Testing 2015\/16\u20132017\/18. Maseru, Lesotho: Ministry of Health; 2015."},{"issue":"9","key":"pone.0292660.ref017","doi-asserted-by":"crossref","first-page":"e1001718","DOI":"10.1371\/journal.pmed.1001718","article-title":"Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies","volume":"11","author":"A Boulle","year":"2014","journal-title":"PLoS medicine"},{"issue":"11","key":"pone.0292660.ref018","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1001\/jama.2018.1818","article-title":"Effect of offering same-day ART vs usual health facility referral during home-based HIV testing on linkage to care and viral suppression among adults with HIV in Lesotho: the CASCADE randomized clinical trial","volume":"319","author":"ND Labhardt","year":"2018","journal-title":"Jama"},{"issue":"1","key":"pone.0292660.ref019","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1186\/s12879-022-07692-w","article-title":"Characteristics and clinical outcomes of patients presenting with advanced HIV disease in the \u201ctreat all\u201d era: a retrospective cohort study from rural Rwanda","volume":"22","author":"G Musengimana","year":"2022","journal-title":"BMC infectious diseases"},{"issue":"2","key":"pone.0292660.ref020","article-title":"Causes and Timing of Mortality and Morbidity Among Late Presenters Starting Antiretroviral Therapy in the REALITY Trial","volume":"66","author":"FA Post","year":"2018","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"issue":"10024","key":"pone.0292660.ref021","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/S0140-6736(16)00546-8","article-title":"Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial","volume":"387","author":"MC Hosseinipour","year":"2016","journal-title":"The Lancet"},{"issue":"2","key":"pone.0292660.ref022","first-page":"588","article-title":"Prevalence and associated factors of TB\/HIV co-infection among HIV Infected patients in Amhara region, Ethiopia","volume":"16","author":"AA Mitku","year":"2016","journal-title":"African health sciences"},{"issue":"306","key":"pone.0292660.ref023","article-title":"Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania","volume":"7","author":"EW Mollel","year":"2019","journal-title":"Frontiers in Public Health"},{"issue":"10","key":"pone.0292660.ref024","first-page":"e438","volume":"2","author":"N Ford","year":"2015","journal-title":"Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis"},{"key":"pone.0292660.ref025","unstructured":"Lesotho Ministry of Health. 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Lesotho Country Operational Plan (COP\/ROP) 2020 Strategic Direction Summary PEPFAR, US Dept. Of State; 2020 3\/16\/2020."},{"issue":"3","key":"pone.0292660.ref032","first-page":"e193","volume":"7","author":"AN Phillips","year":"2020","journal-title":"Updated assessment of risks and benefits of dolutegravir versus efavirenz in new antiretroviral treatment initiators in sub-Saharan Africa: modelling to inform treatment guidelines"},{"issue":"2","key":"pone.0292660.ref033","article-title":"The Continuing Burden of Advanced HIV Disease Over 10 Years of Increasing Antiretroviral Therapy Coverage in South Africa","volume":"66","author":"M Osler","year":"2018","journal-title":"Clinical Infectious Diseases"},{"key":"pone.0292660.ref034","doi-asserted-by":"crossref","DOI":"10.1177\/2325958219847199","article-title":"Advanced HIV Disease among Males and Females Initiating HIV Care in Rural Ethiopia","volume":"18","author":"AR Lifson","year":"2019","journal-title":"J Int Assoc Provid AIDS Care"},{"issue":"2","key":"pone.0292660.ref035","volume":"66","author":"S Carmona","year":"2018","journal-title":"Persistent high burden of advanced HIV disease among patients seeking care in South Africa\u2019s national HIV program: data from a nationwide laboratory cohort"},{"issue":"7","key":"pone.0292660.ref036","doi-asserted-by":"crossref","first-page":"e25546","DOI":"10.1002\/jia2.25546","article-title":"Trends in CD4 and viral load testing 2005 to 2018: multi-cohort study of people living with HIV in Southern Africa","volume":"23","author":"E Zaniewski","year":"2020","journal-title":"Journal of the International AIDS Society"},{"key":"pone.0292660.ref037","article-title":"Treating all people living with HIV in sub-Saharan Africa: a new era calling for new approaches","author":"D Nash","year":"2018","journal-title":"Elsevier"},{"key":"pone.0292660.ref038","doi-asserted-by":"crossref","first-page":"e25530","DOI":"10.1002\/jia2.25530","article-title":"Population\u2010wide differentials in HIV service access and outcomes in the Western Cape for men as compared to women, South Africa: 2008 to 2018: a cohort analysis","volume":"23","author":"M Osler","year":"2020","journal-title":"Journal of the International AIDS Society"},{"key":"pone.0292660.ref039","unstructured":"Ministry of Health GoL. APPROACH TO THE MANAGEMENT OF ADVANCED HIV DISEASE (AHD), Screening, diagnosing, preventing, and treating AHD-related opportunistic infections and other AHD-related conditions. 2020 June 2020."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292660","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T17:37:39Z","timestamp":1697045859000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292660"}},"subtitle":[],"editor":[{"given":"Zewdu Gashu","family":"Dememew","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,10,11]]},"references-count":39,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0292660","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,11]]}}}