Zachariah R, Teck R, Ascurra O, Humblet P, Harries A D
Médecins sans Frontières, Medical Department (Operational Research HIV-TB), Brussels Operational Center, 94 Rue Dupre, Brussels, Belgium.
Trans R Soc Trop Med Hyg. 2006 Jan;100(1):24-31. doi: 10.1016/j.trstmh.2005.06.018. Epub 2005 Sep 30.
Malawi offers antiretroviral treatment (ART) to all HIV-positive adults who are clinically classified as being in WHO clinical stage III or IV without 'universal' CD4 testing. This study was conducted among such adults attending a rural district hospital HIV/AIDS clinic (a) to determine the proportion who have CD4 counts >or=350 cells/microl, (b) to identify risk factors associated with such CD4 counts and (c) to assess the validity and predictive values of possible clinical markers for CD4 counts >or=350 cells/microl. A CD4 count >or=350 cells/microl was found in 36 (9%) of 401 individuals who are thus at risk of being placed prematurely on ART. A body mass index (BMI) >22 kg/m(2), the absence of an active WHO indicator disease at the time of presentation for ART, and a total lymphocyte count >1,200 cells/microl were significantly associated with such a CD4 count. The first two of these variables could serve as clinical markers for selecting subgroups of patients who should undergo CD4 testing. In a resource-limited district setting, assessing the BMI and checking for active opportunistic infections are routine clinical procedures that could be used to target CD4 measurements, thereby minimising unnecessary CD4 measurements, unnecessary (too early) treatment and costs.
马拉维为所有临床分类为世界卫生组织(WHO)临床Ⅲ期或Ⅳ期的HIV阳性成年人提供抗逆转录病毒治疗(ART),而无需进行“常规”CD4检测。本研究在一家农村地区医院的HIV/AIDS诊所就诊的此类成年人中开展,目的是:(a)确定CD4细胞计数≥350个/微升的患者比例;(b)识别与此类CD4细胞计数相关的危险因素;(c)评估CD4细胞计数≥350个/微升的可能临床标志物的有效性和预测价值。在401名有过早接受ART风险的个体中,有36名(9%)的CD4细胞计数≥350个/微升。体重指数(BMI)>22kg/m²、在接受ART时无活跃的WHO指示疾病以及总淋巴细胞计数>1200个/微升与该CD4细胞计数显著相关。这些变量中的前两个可作为临床标志物,用于选择应接受CD4检测的患者亚组。在资源有限的地区环境中,评估BMI和检查是否存在活跃的机会性感染是常规临床程序,可用于确定CD4检测对象,从而将不必要的CD4检测、不必要(过早)的治疗及费用降至最低。