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Evaluating affordable screening markers to detect HIV-1-infected Ugandan adults with CD4 counts of less than 200 cells/mul

Purpose of the study

Can WHO staging, anaemia or low body mass index (LBMI) be used to identify HIV-infected Ugandans with CD4 counts <200 cells/μl?

Methods

From October 1995–April 2006, we screened 3,494 Ugandans, aged 16 years or older, for a cross-sectional study. We analyzed HAART-naïve HIV-infected patients with WHO stages 1–3 who had complete data. Low BMI was BMI<18.5 kg/m2, and anaemia a haemoglobin level<11 or 12 g/dl among women and men, respectively.

Summary of results

We analyzed 2,892 patients with median age of 32 years; 2,055 (71%) women; 1,569 (54%) WHO stage 3; 974 (34%) anaemia; 472 (16%) low BMI; and 1,242 (43%) with CD4 counts <200 cells/μl. WHO stage 3 compared to WHO stages 1 and 2 had sensitivity and specificity (95% CI) of 70% (67, 72) and 57% (55, 60), respectively, to detect CD4 counts <200 cells/μl. Anaemia had sensitivity and specificity (95% CI) of 47% (44, 50) and 76% (74, 78), respectively. Low BMI had sensitivity and specificity (95% CI) of 23% (20, 25) and 89% (87, 90), respectively, against CD4 counts <200 cells/μl. WHO stage 3 or anaemia or low BMI had sensitivity and specificity (95% CI) of 79% (77, 81) and 50% (47, 52), respectively.

Conclusion

Only WHO stage 3 had an acceptable sensitivity to identify patients with CD4 counts of <200 cells/μl in this setting; whilst specificity was modest. Other screening strategies such as on-site low-cost CD4 testing need to be developed to identify patients in need of HAART in rural Africa and other resource-limited settings.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Miiro, G., Todd, J., Nakubulwa, S. et al. Evaluating affordable screening markers to detect HIV-1-infected Ugandan adults with CD4 counts of less than 200 cells/mul. JIAS 11, P11 (2008). https://doi.org/10.1186/1758-2652-11-S1-P11

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  • DOI: https://doi.org/10.1186/1758-2652-11-S1-P11

Keywords

  • Public Health
  • Body Mass Index
  • Infectious Disease
  • Haemoglobin Level
  • Complete Data