Advanced HIV Disease among Persons Newly Diagnosed with HIV: A Hospital-Based Study in Abia State, Nigeria

Abstract

Background and Objective: Advanced HIV disease (AHD), defined by the World Health Organization (WHO) as a CD4 count of fewer than 200 cells/mm³ or WHO stage 3 or 4, remains a significant contributor to AIDS-related mortality despite global antiretroviral therapy (ART) scale-up. This study aimed to determine the prevalence and identify the determinants of AHD among newly diagnosed persons living with HIV in Abia State, Nigeria. Methods: This was a retrospective chart review that analyzed data from patients newly enrolled in the United States centers for disease control and prevention (CDC) human immunodeficiency virus (HIV) ART program in Abia State between October 2021 and September 2023. Data were collected using a proforma designed to capture socio-demographic and clinical variables, including age, gender, residence, marital status, education level, and co-morbidities. Descriptive statistics was conducted to analyze the demographic and clinical characteristics of the participants, while logistic regression was conducted to assess the determinants of advanced HIV disease among ART-naive individuals newly diagnosed with HIV. Results: The prevalence of AHD among the study population was 10.7%. The odds of AHD were significantly lower among individuals aged 26–35 years (aOR = 0.587) and 36–45 years (aOR = 0.638) compared to other age groups. Rural residence was associated with a lower prevalence of AHD (8.6%) compared to urban (13.9%) and semi-urban (12.2%) areas. Individuals with tertiary education (aOR = 0.625) and those employed (aOR = 0.503) showed significantly reduced odds of AHD. Persons identified through outreach testing were associated with a lower prevalence of AHD (2.9%) compared to outpatient department testing (40.2%). Conclusion and Implications for Translation: The study supports targeted community testing to reduce AHD prevalence among persons living with HIV. Expanding outreach programs to urban areas and supporting individuals with lower socioeconomic status are critical. Addressing social determinants of health, particularly education and employment, alongside early ART initiation, can mitigate the progression to advanced disease.