Validation of World Health Organisation HIV/AIDS Clinical Staging in Predicting Initiation of Antiretroviral Therapy and Clinical Predictors of Low CD4 Cell Count in Uganda
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
The WHO clinical guidelines for HIV/AIDS are widely used in resource limited settings to represent the gold
standard of CD4 counts for antiviral therapy initiation. The utility of the WHO-defined stage 1 and 2 clinical factors used in
WHO HIV/AIDS clinical staging in predicting low CD4 cell count has not been established in Uganda. Although the WHO
staging has shown low sensitivity for predicting CD4,200cells/mm3, it has not been evaluated at for CD4 cut-offs of
,250cells/mm3 or ,350 cells/mm3.
Objective: To validate the World Health Organisation HIV/AIDS clinical staging in predicting initiation of antiretroviral
therapy in a low-resource setting and to determine the clinical predictors of low CD4 cell count in Uganda.
Results: Data was collected on 395 participants from the Joint Clinical Research Centre, of whom 242 (61.3%) were classified
as in stages 1 and 2 and 262 (68%) were females. Participants had a mean age of 36.8 years (SD 8.5). We found a significant
inverse correlation between the CD4 lymphocyte count and WHO clinical stages. The sensitivity the WHO clinical staging at
CD4 cell count of 250 cells/mm3 and 350cells/mm3 was 53.5% and 49.1% respectively. Angular cheilitis, papular pruritic
eruptions and recurrent upper respiratory tract infections were found to be significant predictors of low CD4 cell count
among participants in WHO stage 1 and 2.
Conclusion: The WHO HIV/AIDS clinical staging guidelines have a low sensitivity and about half of the participants in stages
1 and 2 would be eligible for ART initiation if they had been tested for CD4 count. Angular cheilitis and papular pruritic
eruptions and recurrent upper respiratory tract infections may be used, in addition to the WHO staging, to improve
sensitivity in the interim, as access to CD4 machines increases in Uganda.
Description
Keywords
World Health Organization, HIV/AIDS Clinical Staging, Antiretroviral Therapy, Clinical Predictors, Low CD4 Cell Count, Uganda
Citation
Baveewo S, Ssali F, Karamagi C, Kalyango JN, Hahn JA, et al. (2011) Validation of World Health Organisation HIV/AIDS Clinical Staging in Predicting Initiation of Antiretroviral Therapy and Clinical Predictors of Low CD4 Cell Count in Uganda. PLoS ONE 6(5): e19089. doi: