Indirect markers to initiate highly active antiretroviral therapy in a rural African setting
Tassie, J-Michel.; Marquardt, T.; Damisoni, H.; Odhiambo, O.Didakus.; Mulemba, M.; Szumilin, E.; Legros, D.
Aids 18(8): 1226-1228
2004
ISSN/ISBN: 0269-9370 PMID: 15166547 DOI: 10.1097/00002030-200405210-00025Document Number: 233743
A study was conducted to evaluate the value of WHO clinical staging, body mass index (BMI), haemoglobinemia and total lymphocyte count (TLC) as markers for initiating highly active antiretroviral therapy (HAART) in a rural African project. The study was conducted in Chiradzulu District Hospital, Malawi. A total of 206 HIV-positive adult patients were included, 135 (66%) following post-test counselling and 71 in median 5 months after testing. The median age was 32 years and 121 (59%) were women. Overall, 125 patients (61%) were eligible for HAART (stage 4 or CD4 cell count <200 cells/ micro l). Overall, 106 patients (52%) had a CD4 cell count of less than 200 cells/ micro l. The CD4 cell count was weakly correlated with BMI (r=0.33), haemoglobinemia (r=0.38) and TLC (r=0.51) (P<0.0001 for each). To identify patients with less than 200 CD4 cells/ micro l, stage 3 or stage 4 presented with similar predictive values. The algorithm stage 3 or 4 or TLC of less than 1200 cells/ micro l had a sensitivity of 93% and a specificity of 49%. The algorithm stage 4 or stages 2-3 with a TLC of less than 1200 cells/ micro l presented with a sensitivity of 61%. Combined with clinical stage and TLC, BMI and haemoglobinemia added little in detecting severe immunodeficiency.