MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
Trop Med Int Health. 2010 Apr;15(4):396-404. doi: 10.1111/j.1365-3156.2010.02471.x. Epub 2010 Feb 17.
To evaluate validity of WHO staging, low body mass index (BMI) and anaemia in detecting HIV-infected adults with CD4+ T-cell counts < 200 cells/microl.
Between October 1995 and April 2006, we screened Ugandans aged 16 or older at enrollment into an open cohort. We analysed highly active anti-retroviral therapy (HAART)-naïve HIV-infected patients with WHO stages 1-3 and complete data in a secondary cross-sectional study. Low BMI was a BMI < 18.5 kg/m(2). Anaemia was a haemoglobin level < 11 or 12 g/dl among women and men respectively.
Among 2892 HAART-naïve patients, the median age was 32 years. 71% were women, 54% had WHO stage 3 AIDS, 34% had anaemia, 16% had a low BMI and 43% had CD4+ T-cell counts < 200 cells/microl. WHO stage 3 compared to combined WHO stages 1 and 2 had a sensitivity (95% CI) of 70% (67, 72) and a specificity of 57% (55, 60) respectively to detect CD4+ T-cell counts < 200 cells/microl. Anaemia compared to normal haemoglobin had sensitivity (95% CI) of 47% (44, 50) and a specificity of 76% (74, 78). Low BMI compared to normal BMI had sensitivity (95% CI) of 23% (20, 25) and a specificity of 89% (87, 90) against CD4+ T-cell counts < 200 cells/microl.
Only WHO stage 3 had reasonably high sensitivity in detecting CD4+ T-cell counts below 200 cells/microl in this setting. Targeted low-cost CD4 testing strategies are urgently needed to detect patients eligible for HAART in rural Africa and other resource-limited settings.
评估世界卫生组织（WHO）分期、低体重指数（BMI）和贫血在检测 CD4+T 细胞计数<200 个/微升的 HIV 感染者中的有效性。
1995 年 10 月至 2006 年 4 月期间，我们在一个开放性队列中对入组的年龄在 16 岁及以上的乌干达人进行了筛查。我们对 WHO 分期为 1-3 期的、接受过高效抗逆转录病毒治疗（HAART）的 HIV 感染者进行了二次横断面研究，分析了这些患者的完全数据。低 BMI 定义为 BMI<18.5kg/m2。贫血定义为血红蛋白水平女性<11g/dl，男性<12g/dl。
在 2892 名未经 HAART 治疗的患者中，中位年龄为 32 岁。71%为女性，54%患有 3 期艾滋病，34%患有贫血，16%的 BMI 较低，43%的 CD4+T 细胞计数<200 个/微升。与合并的 1 期和 2 期相比，3 期 WHO 分期对 CD4+T 细胞计数<200 个/微升的敏感性（95%CI）分别为 70%（67，72）和特异性为 57%（55，60）。与正常血红蛋白相比，贫血对 CD4+T 细胞计数<200 个/微升的敏感性（95%CI）为 47%（44，50），特异性为 76%（74，78）。与正常 BMI 相比，低 BMI 对 CD4+T 细胞计数<200 个/微升的敏感性（95%CI）为 23%（20，25），特异性为 89%（87，90）。
在这种情况下，只有 3 期 WHO 分期对 CD4+T 细胞计数<200 个/微升具有相当高的敏感性。迫切需要针对 CD4+T 细胞计数的低成本检测策略，以检测符合高效抗逆转录病毒治疗条件的患者在农村非洲和其他资源有限的环境中。
