A proposal for basic management of HIV disease in west Africa: use of clinical staging and haemogram data.
Our objective was to propose a strategy to screen HIV-infected African people for biological immunodeficiency easily. In a cross-sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV-infected adults. Peripheral facial paralysis and chronic cutaneo-mucous diseases were the earlier B-stage diseases. Pulmonary tuberculosis was close to B-stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). Ninety per cent of CDC-C stage people had CD4 counts below 350/microliter, whereas only 75% had CD4 counts below 200/microliter. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350/microliter. A simple score (lymphocyte count < or = 2500/microliter and clinical stage > or = B) is proposed to determine this CD4 threshold (positive predictive value: 83%) and to determine those patients needing treatment to prevent wasting and opportunistic infections.
Centre Muraz (Organisation de Coordination et de Coopération pour la Lutte contre les Grandes Endémies) Bobo-Dioulasso, Burkina Faso, Africa. eriledru@pasteur.fr
E
E
Ledru
S
S
Diagbouga
N
N
Meda
P T
PT
Sanou
H
H
Dahourou
S
S
Ledru
A
A
Dembelé
A
A
Zoubga
G
G
Durand
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology; D000328:Adult; D002050:Burkina Faso; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004804:Eosinophils; D015658:HIV Infections / Q000097:blood / Q000628:therapy*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D018655:Lymphocyte Count; D010976:Platelet Count; D014397:Tuberculosis, Pulmonary / Q000209:etiology
D006454:Hemoglobins