Kassa E, Rinke de Wit T F, Hailu E, Girma M, Messele T, Mariam H G, Yohannes S, Jurriaans S, Yeneneh H, Coutinho R A, Fontanet A L
Ethiopian-Netherlands AIDS Research Project, Ethiopian Health and Nutrition Research Institute, Addis Abeba.
AIDS. 1999 Feb 25;13(3):381-9. doi: 10.1097/00002030-199902250-00011.
To study the association between the clinical axis of the World Health Organization (WHO) staging system of HIV infection and disease and laboratory markers in HIV-infected Ethiopians.
Cross-sectional study.
Clinical manifestations and stage of HIV-positive individuals participating in a cohort study of HIV infection progression, and of HIV-positive patients hospitalized with suspicion of AIDS, were compared to CD4+ T-cell count and viral load.
Of the 86 HIV-positive participants of the cohort study, 53 (62%), 16 (19%), 16 (19%), and one (1.2%) were in stage 1, 2, 3 and 4, respectively. Minor weight loss (n = 15) and pulmonary tuberculosis (n = 9) were the most commonly diagnosed conditions among the 38 (44%) symptomatic HIV-positive individuals. Although 23 (27%) HIV-positive participants had CD4+ T-cell counts less than 200 x 10(6)/l, only one was in clinical stage 4. Among 79 hospitalized HIV-positive patients, 15 (19%) and 64 (81%) were in stage 3 and 4, respectively. The majority (83.5%) had CD4+ T-cell counts < 200 x 10(6)/l. Individuals at stage 3 had lower CD4+ T-cell counts and higher viral loads when seen in hospital as compared to cohort participants (P = 0.06 and 0.008, respectively). When grouping the two study populations, the median CD4+ T-cell count decreased (337, 262, 225, 126, and 78 x 10(6)/l, P< 0.01), and the median viral load increased (4.08, 3.89, 4.47, 5.65, and 5.65 log10 copies/ml, P < 0.01), with increasing clinical stage of HIV infection (1, 2, 3 cohort, 3 hospital, and 4, respectively). Median CD4+ T-cell counts were remarkably low in HIV-negative participants (749 x 10(6)/l), and in HIV-positive participants at stage 1 and 2 (337 and 262 x 10(6)/l, respectively).
There was a good correlation between WHO clinical stages and biological markers. CD4+ T-cell counts were low in Ethiopians, particularly during early stages of HIV-1 infection, and preliminary reference values at different stages of HIV-1 infection were determined. In HIV-infected Ethiopians, lymphocyte counts less than 1,000 x 10(6)/l in non-hospitalized individuals, and less than 2,000 x 10(6)/l in hospitalized patients, had high positive predictive value, but low sensitivity, in identifying subjects with low CD4+ T-cell counts (< 200 x 10(6)/l) who would benefit from chemoprophylaxis of opportunistic infections. The on-going longitudinal study will be useful to confirm the prognostic value of the WHO staging system.
研究世界卫生组织（WHO）HIV感染与疾病分期系统的临床分期与埃塞俄比亚HIV感染者实验室指标之间的关联。
横断面研究。
将参与HIV感染进展队列研究的HIV阳性个体以及因疑似艾滋病住院的HIV阳性患者的临床表现和分期，与CD4+T细胞计数和病毒载量进行比较。
在队列研究的86名HIV阳性参与者中，分别有53例（62%）、16例（19%）、16例（19%）和1例（1.2%）处于1期、2期、3期和4期。在38例（44%）有症状的HIV阳性个体中，体重轻度减轻（n = 15）和肺结核（n = 9）是最常见的诊断疾病。虽然23例（27%）HIV阳性参与者的CD4+T细胞计数低于200×10⁶/l，但只有1例处于临床4期。在79例住院的HIV阳性患者中，分别有15例（19%）和64例（81%）处于3期和4期。大多数（83.5%）患者的CD4+T细胞计数<200×10⁶/l。与队列参与者相比，3期患者在住院时的CD4+T细胞计数更低，病毒载量更高（P分别为0.06和0.008）。将两个研究人群分组后，随着HIV感染临床分期的增加（分别为1期、2期、3期队列、3期住院患者和4期），CD4+T细胞计数中位数下降（337、262、225、126和78×10⁶/l，P<0.01），病毒载量中位数增加（4.08、3.89、4.47、5.65和5.65 log₁₀拷贝/ml，P<0.01）。HIV阴性参与者的CD4+T细胞计数中位数非常低（749×10⁶/l），1期和2期HIV阳性参与者的CD4+T细胞计数中位数也很低（分别为337和262×10⁶/l）。
WHO临床分期与生物学标志物之间存在良好的相关性。埃塞俄比亚人CD4+T细胞计数较低，尤其是在HIV-1感染的早期阶段，并确定了HIV-1感染不同阶段的初步参考值。在埃塞俄比亚HIV感染者中，非住院个体淋巴细胞计数低于1000×10⁶/l，住院患者低于2000×10⁶/l，在识别CD4+T细胞计数低（<200×10⁶/l）且能从机会性感染化学预防中获益的受试者方面具有较高的阳性预测价值，但敏感性较低。正在进行的纵向研究将有助于确认WHO分期系统的预后价值。
