Assessing very advanced HIV disease in adolescent girls and young women

Abstract

Background: South Africa has the largest HIV epidemic globally, with ~7.5 million people living with HIV in 2021. Adolescent girls (AG) and young women (YW), aged 15-19 years and 20-24 years, are twice as likely to be living with HIV as their male counterparts. The national HIV prevalence for young women was 9.1% (2021), with limited data on disease severity.

Objectives: This study assessed very advanced HIV disease (CD4 < 100 cells/μL) in adolescent girls and young women (AGYW) in South Africa.

Method: A retrospective descriptive study analysed data collated from the National Health Laboratory Service database for 2017 to 2021 calendar years for AGYW. National and provincial specimen volumes, the percentage of tests with a CD4 < 100 cells/μL and ≥ 100 cells/μL, and the median and interquartile ranges, were calculated. Logistic regression determined the odds ratio for a CD4 < 100 cells/μL, controlling for age category.

Results: Data for 1 199 010 CD4 specimens indicated a significant decrease in volumes of 34% from 287 410 (2017) to 189 533 (2021). The percentage of samples with a count < 100 cells/μL ranged from 4.9% to 5.2% for YW versus 5.6% to 6.1% for AG. Provincial data for a CD4 count < 100 cells/μL ranged between 4.5% and 8.3% in AG and 3.6% to 6.3% for YW. Logistic regression indicated a 24% higher likelihood for AG having a CD4 count < 100 cells/μL.

Conclusion: The study reported a higher proportion of very advanced HIV disease for AG versus YW nationally, with provincial disparity needing further analysis.

Keywords: CD4; HIV; adolescent girls; immune status; young women.

FIGURE 1

Flow chart indicating the number of specimens with a CD4 count < 100 cells/μL with the median indicated for AG and YW in South Africa for calendar years 2017 to 2021. The four age categories with median CD4 counts are indicated: (1) 15–17 years, (2) 18–19 years, (3) 20–22 years and (4) 23–24 years. Data is reported for public-sector testing by the NHLS, South Africa.

FIGURE 2

National analysis of the percentage of CD4 specimens with a count ≤ 10 cells/μL, 11 cells/μL – 29 cells/μL, 30 cells/μL – 49 cells/μL, 50 cells/μL – 99 cells/μL and ≥ 100 cells/μL by calendar year for AG and YW between 2017 and 2021. AG was defined as ages 15–19 years compared to 20–24 for YW. The ≥ 100 cells/μL category is reported on the secondary y-axis. Data are reported for public-sector testing by the NHLS, South Africa.

FIGURE 3

Provincial analysis of the percentage of CD4 specimens with a count ≤ 100 cells/μL for AG and YW for the period from 2017 to 2021. Data are reported for public-sector testing by the NHLS, South Africa.