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Meta-Analysis
. 2023 Aug 22;23(1):549.
doi: 10.1186/s12879-023-08521-4.

Prevalence and trends of advanced HIV disease among antiretroviral therapy-naïve and antiretroviral therapy-experienced patients in South Africa between 2010-2021: a systematic review and meta-analysis

Marcel K Kitenge  1   2 , Geoffrey Fatti  3   4 , Ingrid Eshun-Wilson  3   5 , Omololu Aluko  6 , Peter Nyasulu  3   7
Affiliations
Meta-Analysis

Prevalence and trends of advanced HIV disease among antiretroviral therapy-naïve and antiretroviral therapy-experienced patients in South Africa between 2010-2021: a systematic review and meta-analysis

Marcel K Kitenge et al. BMC Infect Dis. .

Abstract

Background: Despite the significant progress made in South Africa in getting millions of individuals living with HIV into care, many patients still present or re-enter care with Advanced HIV Disease (AHD). We aimed to estimate the prevalence of AHD among ART-naive and ART-experienced patients in South Africa using studies published between January 2010 and May 2022.

Methods: We searched for relevant data on PubMed, CINAHL, Scopus and other sources, with a geographical filters limited to South Africa, up to May 31, 2022. Two reviewers conducted all screening, eligibility assessment, data extraction, and critical appraisal. We synthesized the data using the inverse-variance heterogeneity model and Freeman-Tukey transformation. We assessed heterogeneity using the I2 statistic and publication bias using the Egger and Begg's test.

Results: We identified 2,496 records, of which 53 met the eligibility criteria, involving 11,545,460 individuals. The pooled prevalence of AHD among ART-naive and ART-experienced patients was 43.45% (95% CI 40.1-46.8%, n = 53 studies) and 58.6% (95% CI 55.7 to 61.5%, n = 2) respectively. The time trend analysis showed a decline of 2% in the prevalence of AHD among ART-naive patients per year. However, given the high heterogeneity between studies, the pooled prevalence should be interpreted with caution.

Conclusion: Despite HIV's evolution to a chronic disease, our findings show that the burden of AHD remains high among both ART-naive and ART-experienced patients in South Africa. This emphasizes the importance of regular measurement of CD4 cell count as an essential component of HIV care. In addition, providing innovative adherence support and interventions to retain ART patients in effective care is a crucial priority for those on ART.

Keywords: ART-experienced; ART-naïve; Advanced HIV disease; Burden; South Africa.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart showing search, selection of and final included studies
Fig. 2
Fig. 2
Forest plot of prevalence of AHD among ART-naïve in South Africa, from studies published from 2010–2022
Fig. 3
Fig. 3
Prevalence of AHD among ART-naïve patients in South Africa by age group, from studies published during the period 2010–2022
Fig. 4
Fig. 4
Prevalence of AHD among ART-naïve patients in South Africa by Assessment methods (CD4 count and WHO clinical staging system), from studies published during the period 2010–2022
Fig. 5
Fig. 5
Prevalence of AHD among ART-experienced patients in South Africa, from studies published during the period 2010–2022
Fig. 6
Fig. 6
The time trend of advanced HIV disease from studies published during the period 2010–2022
Fig. 7
Fig. 7
Publication bias prevalence estimate, from studies published during the period 2010–2022
See this image and copyright information in PMC

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