By Zachary Gava
Harare, (New Ziana) – As the global response to HIV and AIDS continues to evolve, a new and deadly threat is emerging in its shadow—Advanced HIV Disease (AHD).
Despite remarkable progress in the fight against HIV, thousands of lives are still being lost, not to AIDS, but to a far less understood but increasingly dangerous condition.
According to Dr. Tich Nyamundanya, a leading health expert from Zimbabwe Health Interventions, who spoke at a recent media editors’ workshop, AHD is now a more pressing medical challenge than AIDS itself.
“Advanced HIV Disease is silently taking lives, even when people are on antiretroviral treatment,” Dr. Nyamundanya warned.
“We are seeing too many cases where individuals either present late, having never started treatment, or return to care after long absences, only to find themselves already in the grip of AHD.”
For adults and adolescents, AHD is diagnosed when CD4 cell counts fall below 200 cells per cubic millimetres, or when an individual experiences certain clinical symptoms classified under World Health Organisation (WHO) stage 3 or 4 events.
In WHO HIV clinical staging, Stage 3 involves severe weight loss of over 10 percent of body weight, while Stage 4 includes HIV wasting syndrome, which features extreme weight loss (also over 10 percent along with chronic fever and/or diarrhoea.
For children under five years of age, the situation is even more severe.
“We consider any HIV-positive child under five to have advanced HIV disease unless they have been on Anti-Retroviral Therapy (ART) for at least 12 months and are clinically stable,” Dr. Nyamundanya explained.
The reality is sobering: in sub-Saharan Africa, more than one in three people living with HIV begin ART already facing AHD.
Alarmingly, around 10 percent of them die within just the first three months of treatment. These are not statistics borne out of treatment failure, but rather a failure to detect and manage the opportunistic infections that often accompany advanced disease.
“People think ART is enough,” said Dr. Nyamundanya. “But ART alone won’t save someone already fighting TB, cryptococcal meningitis, or a severe bacterial infection. These conditions kill, even with treatment.”
Men are especially vulnerable because they are diagnosed with AHD 1.6 times more often than women. This is often due to poor health-seeking behaviour, delayed testing, and inconsistent treatment. Many men seek medical help only after their health has significantly deteriorated.
Children fare no better. Data from the World Health Organization shows that over 80 percent of children under five years old start ART with either severe immune suppression or already in WHO stage 3 or 4. These young lives are at extreme risk if advanced disease is not diagnosed early and treated promptly.
But AHD does not just affect the treatment-naïve. Even those who have been on ART are not immune.
Dr. Nyamundanya emphasised that anyone living with HIV who has interrupted treatment for 90 days or more, or suspects their treatment is failing, should be screened for AHD.
“Don’t assume you’re okay just because you’re on medication,” he urged. “You might be feeling fine, but without screening, life-threatening infections can go unnoticed until it’s too late.”
Screening for TB and cryptococcal meningitis, he said, is one of the most effective life-saving interventions currently available. These infections, while deadly, are preventable and treatable if caught early.
“We have the tools to stop these deaths,” Dr. Nyamundanya added. “But if we don’t use them, we will continue to bury people who could have been saved.”
What makes the threat of AHD even more dangerous is how little it is discussed in public spaces. And this is where Dr. Nyamundanya believes the media can play a transformative role.
“As media professionals, you shape public understanding. You influence action. Be the voice. Use your platforms to inform people that HIV treatment is more than just taking ART—it’s about full clinical management that includes prevention of advanced disease,” he said.
He called on editors and journalists to dig deeper into the narrative, to go beyond the success stories of ART coverage and address the lives still slipping through the cracks.
“Educate your audiences. Let them know that starting ART is not the end of the journey. Regular check-ups, screening, and early interventions are what save lives.”
Dr. Nyamundanya’s message is clear: silence is no longer an option. Advanced HIV Disease may not have the same visibility as AIDS, but it is claiming lives every day.
With increased awareness, timely screening, and a commitment from both health professionals and the media, these deaths can be prevented. “We must act now,” he said. “Because every life lost to AHD is a life that could have been saved.”
New Ziana
