Grey nails predict low CD4 cell count among untreated patients with HIV infection in Malawi.
Scarborough, Matthew;
Gordon, Stephen B;
French, Neil;
Phiri, Chimota;
Musaya, Janelisa;
Zijlstra, Eduard E;
(2006)
Grey nails predict low CD4 cell count among untreated patients with HIV infection in Malawi.
AIDS (London, England), 20 (10).
pp. 1415-1417.
ISSN 0269-9370
DOI: https://doi.org/10.1097/01.aids.0000233575.26349.cc
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
BACKGROUND: Alternative criteria for initiating antiretroviral therapy to CD4 testing or clinical illness are needed in Malawi. METHOD: We tested if grey nails could be used to identify patients with a CD4 cell count less than 200 cells/microl who had not yet presented with AIDS-defining illnesses. RESULTS: Using a set of 242 photographs we showed good inter-observer agreement for grey nails (kappa = 0.66; P < 0.0001) and the positive predictive value of grey nails for a CD4 cell count of less than 200 cells/microl was 81% (chi < 0.0001). CONCLUSIONS: Grey nails have been associated with HIV infection and we have shown significant correlation of this sign with a low CD4 cell count. For clinicians working in sub-Saharan Africa without access to CD4 cell count testing, grey or DB nails represent an additional staging sign to help identify a sub-group of patients likely to benefit from ART.
