Retrospective analysis of CD4 count trends in South Africa.

Background: South Africa has the largest HIV epidemic globally. Despite the scale-up of antiretroviral therapy, people living with HIV are still presenting with low CD4 counts.

Objectives: This study assessed CD4 trends.

Method: A retrospective analysis of laboratory data from 2013 to 2023 was conducted. Annual test volumes, the median CD4, and the percentage of specimens with a count ≤ 200 cells/µL and > 500 cells/µL were reported at the national and provincial levels, and by age and gender. The percentage change in both CD4 categories between 2013 and 2023 was assessed, and the CD4 counts per 100 000 population reported.

Results: Data are reported for 32 154 644 specimens. The overall median CD4 increased from 396 cells/µL to 473 cells/µL. The percentage of specimens with CD4 counts > 500 cells/µL increased over time but the percentage with CD4 counts ≤ 200 cells/µL remained stable. Men had lower CD4 median and higher percentage of specimens with counts ≤ 200 cells/µL than women. However, the rate of, CD4 ≤ 200 cells/µL decreased from 1411 to 700 per 100 000 population; this decrease occurred in all provinces except the Western Cape.

Conclusion: This study found high percentage of specimens with CD4 counts ≤ 200 cells/µL despite an increase in median CD4 count. Men had lower CD4 counts than women.