Confronting Advanced HIV Disease: Why It Still Matters

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When we talk about HIV in 2025, the story we often hear is about progress: more people than ever are on treatment, new prevention methods are available, and the science of HIV cure is advancing. Yet, behind this progress lies a quieter crisis, Advanced HIV Disease (AHD).

What Is Advanced HIV Disease?

The World Health Organisation (WHO) defines Advanced HIV Disease as when a person has a CD4 count below 200 cells/mm³ or is in WHO clinical stage 3 or 4. For children younger than five years, any HIV infection is considered advanced because of their high vulnerability. People with AHD are extremely vulnerable to severe opportunistic infections such as cryptococcal meningitis, tuberculosis, histoplasmosis, and Pneumocystis pneumonia, alongside weight loss, persistent fevers, and other life-threatening complications.

Why Does AHD Still Happen?

One might ask: If treatment is widely available, why are people still reaching this stage? The reasons are complex:

  • Late diagnosis: WHO data show that at least one-third of people entering HIV care present with advanced HIV disease, based on an analysis of over 1.8 million individuals across 117 cohorts in 52 countries. In sub-Saharan Africa, between 20% and 40% of people living with HIV still present with AHD at the time of diagnosis or when re-engaging in care.
  • Treatment interruption: Many people disengage from care due to stigma, side-effects, migration, or health system failures, and return to care much later.
  • Health system gaps: Not all facilities are equipped to provide the full “AHD package of care,” including rapid diagnostics, access to life-saving medicines, and appropriate hospital or palliative care.
  • Social and structural barriers: Poverty, gender inequality, discrimination, and criminalisation of key populations often block people from accessing services early.

The Human Cost

AHD is not just a clinical condition; it is a story of human suffering. People often arrive in hospitals very ill, sometimes dying within days of admission. Families face not only grief but also stigma and financial strain. Globally, over 4 million adults are estimated to be living with AHD, and in 2021 alone, there were around 650,000 HIV-related deaths, most linked to advanced disease or complications that could have been prevented with timely care.

What Needs to Be Done

The good news is that AHD is preventable and treatable, if health systems respond effectively. Solutions include:

  • Routine screening and early intervention: Using CD4 testing and point-of-care diagnostics to identify people at risk.
  • The AHD package of care: WHO recommends a combination of prophylaxis, rapid diagnosis, and treatment for major opportunistic infections, plus ART re-initiation.
  • Stronger hospital-to-community linkages: Many patients die after being discharged because they are not properly followed up. Continuity of care is essential.
  • Integration of palliative care: Beyond survival, people with AHD need relief from pain and distress.
  • Community engagement: PLHIV networks and support groups must be central, addressing stigma, offering peer navigation, and supporting adherence.

Why This Matters Now

As we celebrate advances in HIV prevention, treatment, and cure research, we cannot forget those still being left behind. AHD reminds us that equity is the unfinished business of the HIV response. Global health leaders, governments, and communities must prioritise AHD, not as a remnant of the past, but as an urgent challenge today.

The upcoming Lancet Commission on Advanced HIV Disease, which I am honoured to support, offers an opportunity to shine a light on this neglected crisis. By combining evidence, policy analysis, and community voices, the Commission will help chart a path to reduce preventable suffering and death.

A Call to Action

Ending AIDS is not only about reaching 95-95-95 targets, but also about ensuring no one dies from preventable and treatable conditions. We must invest in stronger health systems, community-centred care, and policies that keep people from falling through the cracks.

Because until we end the suffering caused by Advanced HIV Disease, the story of HIV is not complete.

Welcome to my blog dedicated to community engagement in HIV research. Here, we delve deep into the latest advancements and discussions surrounding HIV cure, treatment, prevention, and management of advanced HIV infection. My goal is to bridge the gap between complex scientific research and community understanding, ensuring that knowledge is accessible and actionable. Join me as I explore these critical topics, engage with community insights, and contribute to the ongoing fight against HIV.

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