Limitations of the WHO/CDC clinical case definition for AIDS in Africa.

Abstract

The authors screened 268 patients over the period July-September 1990 selected by systematic sample from those attending the sexually transmitted diseases section of the adult filter clinic at the University Teaching Hospital in Lusaka Zambia. Clinical findings were recorded to establish whether each patient fulfilled the World Health Organization (WHO) clinical case definition for AIDS. For pragmatic reasons the presence of oral candida any episode of herpes simplex and any episode of herpes zoster were considered positive criteria. Participants were also examined for the presence of palpable epitrochlear lymph nodes enlarged to one centimeter or more. Blood was drawn for analysis for HIV-1 antibody using HIVCHEK and for syphilis using Syfacard-R. 158 participants were found to be HIV-1 seropositive. It was also determined that current WHO criteria for the clinical case definition of AIDS offers only low positive predictive value and sensitivity. The authors therefore urge that caution be taken in interpreting that case definition and that serological testing for HIV be used in conjunction with the clinical case definition whenever possible. HIVCHEK can be routinely used in areas where there is no serological evidence of HIV-2. Furthermore epitrochlear adenopathy is a simple clinical finding which has in this study a positive predictive value for HIV infection of 77%; a similar study in Zambia showed a positive predictive value of 89%. Further studies are needed to validate this finding in other settings but the presence of the nodes may provide an additional clinical criterion for predicting HIV seropositivity in the absence of other known causes of epitrochlear lymphadenopathy.