Prevalence of advanced HIV disease, cryptococcal antigenemia and suboptimal clinical outcomes among those enrolled in care in Vietnam.

BACKGROUND People living with advanced HIV disease (AHD) are at high risk of morbidity and mortality. We assessed the prevalence of cryptococcal antigenemia (CrAg) and clinical outcomes among patients newly presenting with CD4 ≤100 cells/μL in Vietnam. SETTING Twenty-two public HIV clinics in Vietnam. METHODS During August 2015-March 2017, ART-naive adults presenting for care with CD4 ≤100 cells/μL were screened for CrAg. Those who consented to study enrollment were followed for up to 12 months and assessed for clinical outcomes. RESULTS Of 3,504 patients with CD4 results, 1,354 (38.6%) had CD4 ≤100 cells/μL, of whom 1,177 (86.9%) enrolled in the study. Median age was 35 years (interquartile range 30-40); 872 (74.1%) were male, and 892 (75.8%) had CD4 <50 cells/μL. Thirty-six (3.1%) were CrAg positive. Overall 1,151 (97.8%) including all who were CrAg positive initiated ART. Of 881 (76.5%) followed for ≥12 months, 623 (70.7%) were still alive and on ART at 12 months, 54 (6.1%) had transferred to non-study clinics, 86 (9.8%) were lost to follow up (LTFU), and 104 (11.8%) had died. Among all 1,177 study participants, 143 (12.1%) died, most (123, 86.0%) before or within 6 months of enrollment. Twenty-seven (18.9%) died from pulmonary tuberculosis, 23 (16.1%) from extrapulmonary tuberculosis, 8 (5.6%) from Talaromyces marneffei infection, and 6 (4.2%) from opioid overdose. Eight deaths (5.8%) occurred among the 36 CrAg positive individuals. CONCLUSIONS Late presentation for HIV care was common. The high mortality after entry in care calls for strengthening of the management of AHD.