Page I D, McKew S J, Kudzala A G, Fullwood C, van Oosterhout J J, Bates I
University of Manchester, Respiratory Research Group, 3rd floor ERC, Wythenshaw Hospital, Southmoor Road, Manchester M23 9LT, UK.
Int J STD AIDS. 2013 Jun;24(6):449-53. doi: 10.1177/0956462412472832. Epub 2013 Jun 18.
Clinical staging determines antiretroviral therapy (ART) eligibility when CD4 count is not available. Haemoglobin (Hb) ≤8 g/dL is an indication for the treatment. We measured Hb in HIV-positive Malawian adults undergoing clinical assessment for ART eligibility and calculated the percentage of patients with CD4 ≤ 350 cells/μL deemed eligible for ART by clinical staging with and without Hb measurement, using the existing threshold and an alternative proposed after comparing Hb values to CD4 counts. Three hundred and thirty-eight patients had CD4 counts measured and 226 (67%) had CD4 ≤ 350 cells/μL. Thirty-six (16%) patients with low CD4 count were eligible for ART by clinical assessment alone, 48 (21%) when Hb was also measured with a threshold of ≤8 g/dL and 74 (34%) with a threshold of ≤10 g/dL. Measuring Hb alongside clinical assessment could increase the number of patients with CD4 ≤ 350 cells/μL starting ART by 33% using a threshold of Hb ≤ 8 g/dL or 114% with a threshold of ≤10g/dL.
当无法获取CD4细胞计数时，临床分期可确定抗逆转录病毒疗法（ART）的适用资格。血红蛋白（Hb）≤8 g/dL是治疗的一项指征。我们对接受ART适用资格临床评估的HIV阳性马拉维成年人测量了Hb，并计算了根据现有阈值以及在将Hb值与CD4细胞计数进行比较后提出的替代阈值，在有和没有测量Hb的情况下，通过临床分期被判定符合ART治疗条件的CD4≤350个细胞/μL患者的百分比。338例患者进行了CD4细胞计数测量，其中226例（67%）的CD4≤350个细胞/μL。仅通过临床评估，36例（16%）CD4细胞计数低的患者符合ART治疗条件；当测量Hb且阈值为≤8 g/dL时，48例（21%）符合条件；当阈值为≤10 g/dL时，74例（34%）符合条件。在临床评估的同时测量Hb，使用Hb≤8 g/dL的阈值可使开始接受ART治疗的CD4≤350个细胞/μL患者数量增加33%，使用≤10 g/dL的阈值则可增加114%。
