Clinical signs and symptoms in the assessment of immunodeficiency in men with subtype C HIV infection in Harare, Zimbabwe.
OBJECTIVE
Providing low-cost interventions such as co-trimoxazole as prophylaxis against opportunistic infections among HIV-infected individuals depends on the identification of those at risk. This article describes the prevalence of self-reported signs and symptoms and CD4 cell counts in a cohort of 447 HIV seropositive men. A scoring system using self-reported signs and symptoms was developed and tested in the prediction of low CD4 cell counts. This approach may allow health care providers in low-resource settings to predict severe immunodeficiency and to provide care.


METHODS
Data on clinical manifestations of HIV infection and blood samples for HIV serology were collected prospectively from an ambulatory cohort of men seen at their workplace at enrollment and every 6 months thereafter. CD4+ cell counts were obtained on samples testing positive on ELISA. Using data reduction techniques and logistic modeling, we developed a prognostic score system.


RESULTS
20% of the men had CD4+ cell counts below 200. All reported signs and symptoms were more frequent in men with less than 200 CD4+ cell counts compared to men with CD4+ cell counts greater than 200. History of malaria, fever, lymphadenopathy, persistent diarrhea, persistent cough, and skin infections robustly predicted low CD4+ count. A scoring system equation was developed based on the coefficients of the multivariate logistic regression: 1x(tuberculosis) + 3.2x(herpes zoster) + 4.5x(malaria) + 5.7x(fever) + 5.8x(cough) + 8.2x(lymphadenopathy) + 8.5x(skin infection). Setting the score cutoff value greater than or equal 5, the model had moderately high sensitivity of 61% and specificity of 72%. The scoring system had an overall classification error rate of 30%.


CONCLUSIONS
By using this simple scoring system, physicians can correctly identify 72% of patients who do not require immediate intervention, thereby channeling scarce resources to those who have both low CD4+ cell counts and symptoms and are most likely to benefit from prophylactic and antiretroviral interventions.
Machekano
Rhoderick
R
AIDS Clinical Trials, Stanford University Medical School, Stanford, California, USA. rodmach@stanford.edu
Bassett
Mary
M
McFarland
Willi
W
Katzenstein
David
D
D017088:AIDS-Related Opportunistic Infections / Q000503:physiopathology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D006678:HIV / Q000145:classification; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015030:Zimbabwe