A simple clinical and paraclinical score predictive of CD4 cell counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal

In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple...

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Bibliographic Details
Published in:Transactions of the Royal Society of Tropical Medicine and Hygiene 2002-04, Vol.96 (2), p.167-172
Main Authors: Pistone, T., Kony, S., Faye-Niang, M.A., Ndour, C.T., Gueye, P.M., Henzel, D., Delaporte, E., Badiane, S., N'Doye, I., Coulaud, J.P., Larouzé, B., Bouchaud, O.
Format: Article
Language:English
Subjects:
Anemias. Hemoglobinopathies
Biological and medical sciences
CD4+ T lymphocytes
chemoprophylaxis
clinical score
co-trimoxazole
Diseases of red blood cells
Hematologic and hematopoietic diseases
HIV infections
Human viral diseases
Infectious diseases
Medical sciences
Senegal
Tropical medicine
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index < 22 (+2), herpes zoster (+4), tuberculin induration < 5 mm (+3) and haemoglobin ≤ 10 g/dL (+1). A score of ≥ 4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis.
ISSN:0035-9203
1878-3503
DOI:10.1016/S0035-9203(02)90292-0