Evaluation of affordable screening markers to detect CD4+ T-cell counts below 200 cells-kl among HIV-1-infected Ugandan adults

• Published in: Tropical medicine & international health 2010-04, Vol.15 (4), p.396-404
• Main Authors: Miiro, G, Nakubulwa, S, Watera, C, Munderi, P, Floyd, S, Grosskurth, H
• Format: Article
• Language: English
• Subjects: Human immunodeficiency virus
• ISSN: 1360-2276
• DOI: 10.1111/j.1365-3156.2010.02471.x

SummaryObjective To evaluate validity of WHO staging, low body mass index (BMI) and anaemia in detecting HIV-infected adults with CD4+ T-cell counts < 200 cells-kl.Methods Between October 1995 and April 2006, we screened Ugandans aged 16 or older at enrolment into an open cohort. We analysed highly active anti-retroviral therapy (HAART)-naive HIV-infected patients with WHO stages 1-3 and complete data in a secondary cross-sectional study. Low BMI was a BMI < 18.5 kg-m2. Anaemia was a haemoglobin level < 11 or 12 g-dl among women and men respectively.Results Among 2892 HAART-naive patients, the median age was 32 years. 71% were women, 54% had WHO stage 3 AIDS, 34% had anaemia, 16% had a low BMI and 43% had CD4+ T-cell counts < 200 cells-kl. WHO stage 3 compared to combined WHO stages 1 and 2 had a sensitivity (95% CI) of 70% (67, 72) and a specificity of 57% (55, 60) respectively to detect CD4+ T-cell counts < 200 cells-kl. Anaemia compared to normal haemoglobin had sensitivity (95% CI) of 47% (44, 50) and a specificity of 76% (74, 78). Low BMI compared to normal BMI had sensitivity (95% CI) of 23% (20, 25) and a specificity of 89% (87, 90) against CD4+ T-cell counts < 200 cells-kl.Conclusion Only WHO stage 3 had reasonably high sensitivity in detecting CD4+ T-cell counts below 200 cells-kl in this setting. Targeted low-cost CD4 testing strategies are urgently needed to detect patients eligible for HAART in rural Africa and other resource-limited settings. Evaluation des marqueurs de depistage abordables pour detecter les taux de cellules T CD4 + en dessous de 200 cellules-kl chez les adultes ougandais infectes par le VIH-1Objectif: Evaluer la validite des stades de l'OMS, faible indice de masse corporelle (IMC) et anemie dans la detection des adultes infectes par le VIH avec des taux de lymphocytes T CD4 + < 200 cellules-kl.Methodes: Entre Octobre 1995 et Avril 2006, nous avons investigue des Ougandais ages de 16 ans ou plus pour l'enrolement dans une cohorte ouverte. Nous avons analyse de patients infectes par le VIH naifs pour le HAART avec des stades 1a 3 de l'OMS et des donnees completes dans une etude transversale secondaire. La faible IMC etait un IMC