Diagnostic accuracy of three clinical case definitions for advanced HIV disease.
OBJECTIVE
To assess the accuracy of three clinical case definitions for advanced HIV disease: the World Health Organization (WHO) case definition, and the original and revised Caracas case definitions.


METHODS
Retrospective chart review.


METHODS
A clinic for patients with all stages of HIV infection at the Johns Hopkins Hospital, Baltimore, [correction of Bethesda] Maryland, USA, a tertiary care university hospital.


METHODS
Two hundred and twenty-four HIV-positive adults who underwent initial evaluation between 1 January 1990 and 31 December 1990.


METHODS
A score for each definition was assigned based on initial evaluation. The sensitivity, specificity, and predictive values were calculated using the Centers for Disease Control (CDC) staging criteria, and results were correlated with total CD4 cell counts.


RESULTS
The sensitivities of the WHO, and the original and revised Caracas definitions were 40, 67, and 60%, respectively, using CDC disease stage IV as a positive standard. Specificities were between 99 and 100%, using CDC stage II-III disease as a negative standard. Mean CD4 cell counts for patients with positive scores were 184, 160, and 158 x 10(6)/l, respectively, compared to 191 x 10(6)/l for CDC stage IV patients. Sensitivity was lower when the positive standard was expanded to include all patients with CD4 cell counts less than 200 x 10(6)/l.


CONCLUSIONS
In our study population, case definitions were specific, but only moderately sensitive for advanced HIV disease. Prospective studies should be conducted in diverse geographic regions, using lymphocyte or CD4 cell counts when possible.
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J E
JE
Gallant
J
J
Somani
R E
RE
Chaisson
D
D
Stanton
M
M
Smith
T C
TC
Quinn
D000163:Acquired Immunodeficiency Syndrome / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D001938:Brazil; D015496:CD4-Positive T-Lymphocytes; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States; D014944:World Health Organization