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


Miiro, G; Nakubulwa, S; Watera, C; Munderi, P; Floyd, S; Grosskurth, H; (2010) Evaluation of affordable screening markers to detect CD4+T-cell counts below 200 cells/mu l among HIV-1-infected Ugandan adults. Tropical medicine & international health, 15 (4). pp. 396-404. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2010.02471.x

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Abstract

OBJECTIVE 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/mu l. 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/m(2). 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/mu l. 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/mu l. 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/mu l. CONCLUSION Only WHO stage 3 had reasonably high sensitivity in detecting CD4+ T-cell counts below 200 cells/mu l 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.

Item Type: Article
Keywords: markers, screening, CD4, highly active anti-retroviral therapy, Africa, immunodeficiency-virus-infection, body-mass index, antiretroviral, therapy, controlled-trial, hiv-infection, disease, progression, population, microchip, settings
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
Population Studies Group
Tropical Epidemiology Group
PubMed ID: 20180936
Web of Science ID: 275530600003
URI: http://researchonline.lshtm.ac.uk/id/eprint/3930

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