title: Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers.
abstract: OBJECTIVE
  To study the association between the clinical axis of the World Health Organization (WHO) staging system of HIV infection and disease and laboratory markers in HIV-infected Ethiopians.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Clinical manifestations and stage of HIV-positive individuals participating in a cohort study of HIV infection progression, and of HIV-positive patients hospitalized with suspicion of AIDS, were compared to CD4+ T-cell count and viral load.
  
  
  RESULTS
  Of the 86 HIV-positive participants of the cohort study, 53 (62%), 16 (19%), 16 (19%), and one (1.2%) were in stage 1, 2, 3 and 4, respectively. Minor weight loss (n = 15) and pulmonary tuberculosis (n = 9) were the most commonly diagnosed conditions among the 38 (44%) symptomatic HIV-positive individuals. Although 23 (27%) HIV-positive participants had CD4+ T-cell counts less than 200 x 10(6)/l, only one was in clinical stage 4. Among 79 hospitalized HIV-positive patients, 15 (19%) and 64 (81%) were in stage 3 and 4, respectively. The majority (83.5%) had CD4+ T-cell counts < 200 x 10(6)/l. Individuals at stage 3 had lower CD4+ T-cell counts and higher viral loads when seen in hospital as compared to cohort participants (P = 0.06 and 0.008, respectively). When grouping the two study populations, the median CD4+ T-cell count decreased (337, 262, 225, 126, and 78 x 10(6)/l, P< 0.01), and the median viral load increased (4.08, 3.89, 4.47, 5.65, and 5.65 log10 copies/ml, P < 0.01), with increasing clinical stage of HIV infection (1, 2, 3 cohort, 3 hospital, and 4, respectively). Median CD4+ T-cell counts were remarkably low in HIV-negative participants (749 x 10(6)/l), and in HIV-positive participants at stage 1 and 2 (337 and 262 x 10(6)/l, respectively).
  
  
  CONCLUSIONS
  There was a good correlation between WHO clinical stages and biological markers. CD4+ T-cell counts were low in Ethiopians, particularly during early stages of HIV-1 infection, and preliminary reference values at different stages of HIV-1 infection were determined. In HIV-infected Ethiopians, lymphocyte counts less than 1,000 x 10(6)/l in non-hospitalized individuals, and less than 2,000 x 10(6)/l in hospitalized patients, had high positive predictive value, but low sensitivity, in identifying subjects with low CD4+ T-cell counts (< 200 x 10(6)/l) who would benefit from chemoprophylaxis of opportunistic infections. The on-going longitudinal study will be useful to confirm the prognostic value of the WHO staging system.
authors: Ethiopian-Netherlands AIDS Research Project, Ethiopian Health and Nutrition Research Institute, Addis Abeba.
authors: E
authors: E
authors: Kassa
authors: T F
authors: TF
authors: Rinke de Wit
authors: E
authors: E
authors: Hailu
authors: M
authors: M
authors: Girma
authors: T
authors: T
authors: Messele
authors: H G
authors: HG
authors: Mariam
authors: S
authors: S
authors: Yohannes
authors: S
authors: S
authors: Jurriaans
authors: H
authors: H
authors: Yeneneh
authors: R A
authors: RA
authors: Coutinho
authors: A L
authors: AL
authors: Fontanet
mesh_terms: D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005069:Evaluation Studies as Topic; D015658:HIV Infections / Q000145:classification* / Q000503:physiopathology*; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D019562:Viral Load; D014944:World Health Organization
chemical_list: D015415:Biomarkers