Boniphace Idindili, Omari Minzi, Susan Fred Rumisha, Ferdinand Mugusi, Marcel Tanner
Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland.
Open AIDS J. 2011;5:9-16. doi: 10.2174/1874613601105010009. Epub 2011 Mar 7.
Tanzania HIV/AIDS management follows WHO clinical staging which requires CD4 counts as complement. Lacking CD4 counts facilities in rural health facilities remains a challenge. Simplified and sensitive clinical staging based on local clinical patterns is useful to ensure effective care without CD4 counts.
To assess whether local HIV clinical manifestations can be used to guide HIV management in settings with limited access to CD4 counts in Tanzania.
A Cross-sectional study conducted at Tumbi and Chalinze health facilities documented clinical manifestations and CD4 counts in 360 HIV/AIDS patients. Simplified management groups comprised of severe and moderate disease were formed based on clinical manifestations and CD4 counts results. Symptoms with high frequency were used to predict severe disease.
A Weight loss (48.3%) and chronic cough (40.8 %) were the most reported manifestations in the study population. More than 50% of patients presented with CD4≤200. Most symptoms were found to be highly sensitive (71% to 93%) in predicting severe immunosuppression using CD4<200 cut-off point as a 'Gold standard'. Chronic diarrhoea presented in 10.6%, and predicted well severe immunosuppression either alone (OR 1.95, 95%CI, 0.95-4.22) or in combination (OR 4.21, 95%CI 0.92-19.33) with other symptoms. Basing strictly on WHO clinical staging 30.8% of patients were detected to be severely immunosuppressed (Stage 4). While using our proposed management categories of severe and moderate immunosuppression 70% of patients were put into the severe immunosuppression group, consistent with CD4 cut-off count of≤350.
HIV/AIDS clinics managing large cohorts should develop validated site specific guidelines based on local experiences. Simplified guidelines are useful for resource constrained settings without CD4 counting facilities.
坦桑尼亚的艾滋病毒/艾滋病管理遵循世界卫生组织的临床分期，这需要CD4细胞计数作为补充。农村卫生设施缺乏CD4细胞计数设备仍然是一个挑战。基于当地临床模式的简化且敏感的临床分期有助于在没有CD4细胞计数的情况下确保有效的治疗。
评估在坦桑尼亚获得CD4细胞计数有限的情况下，当地的艾滋病毒临床表现是否可用于指导艾滋病毒管理。
在通比和查林泽卫生设施进行的一项横断面研究记录了360名艾滋病毒/艾滋病患者的临床表现和CD4细胞计数。根据临床表现和CD4细胞计数结果形成了由严重和中度疾病组成的简化管理组。使用高频症状来预测严重疾病。
体重减轻（48.3%）和慢性咳嗽（40.8%）是研究人群中报告最多的表现。超过50%的患者CD4≤200。以CD4<200作为“金标准”，大多数症状在预测严重免疫抑制方面具有高度敏感性（71%至93%）。慢性腹泻的发生率为10.6%，单独（比值比1.95，95%置信区间，0.95 - 4.22）或与其他症状联合（比值比4.21，95%置信区间0.92 - 19.33）时能很好地预测严重免疫抑制。严格按照世界卫生组织临床分期，30.8%的患者被检测为严重免疫抑制（4期）。而使用我们提出的严重和中度免疫抑制管理类别时，70%的患者被归入严重免疫抑制组，这与CD4截止计数≤350一致。
管理大量患者群体的艾滋病毒/艾滋病诊所应根据当地经验制定经过验证的特定地点指南。简化指南对没有CD4计数设备的资源受限环境很有用。
