Abstract
In a routine service delivery setting in Uganda, we assessed the ability of the WHO clinical stage to accurately identify HIV-infected patients in whom antiretroviral therapy should be started.Among 4302 subjects screened for ART, the sensitivity and specificity (95% CI) of WHO stage III, IV against a CD4 count < 200 × 106/l were 52% (50, 54%) and 68% (66, 70%) respectively. Plasma viral load was tested in a subset of 1453 subjects in whom ART was initiated. Among 938 subjects with plasma viral load of 100,000 copies or more, 391 (42%, 95% CI 39, 45%) were at WHO stage I or II.In this setting, a large number of individuals could have been denied access to antiretroviral therapy if eligibility to ART was assessed on the basis of WHO clinical stage. There is an urgent need for greater CD4 count testing and evaluation of the utility of plasma viral load prior to initiation of ART to accompany the roll-out of ART.
Highlights
In developed countries, CD4 count and plasma viral load testing are essential for monitoring HIV-infected subjects and for assessing when antiretroviral therapy (ART) should be initiated [1]
This study shows that about a half of subjects with World Health Organisation (WHO) stage I or II, as assessed in routine health service delivery in a typical African setting, had CD4 count
In the many settings in Africa, where CD4 count testing is not available, initiation of ART will have been deferred in these patients until they reached a more advanced HIV clinical stage when their CD4 count will have dropped and plasma viral load increased even further
Summary
CD4 count and plasma viral load testing are essential for monitoring HIV-infected subjects and for assessing when antiretroviral therapy (ART) should be initiated [1]. Many settings do not have the resources to test CD4 counts and plasma viral load and in these areas, a patient's HIV stage is assessed on the basis of clinical criteria alone, using the World Health Organisation (WHO) HIV clinical staging. Those at WHO stage III or IV can be eligible for ART (provided that they satisfy psychosocial and other criteria) [2,3]. A hospital-based study conducted in Cambodia reported limited added value of using CD4 count in addition to the WHO HIV clinical staging when assessing patients for ART but the (page number not for citation purposes)
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