title: A simple clinical and paraclinical score predictive of CD4 cells counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal.
abstract: In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index < 22 (+2), herpes zoster (+4), tuberculin induration < 5 mm (+3) and haemoglobin < or = 10 g/dL (+1). A score of > or = 4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis.
authors.affiliation: Institut de Médecine et d'Epidémiologie Africaines, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Pistone
authors.forename: S
authors.initials: S
authors.lastname: Kony
authors.forename: M A
authors.initials: MA
authors.lastname: Faye-Niang
authors.forename: C T
authors.initials: CT
authors.lastname: Ndour
authors.forename: P M
authors.initials: PM
authors.lastname: Gueye
authors.forename: D
authors.initials: D
authors.lastname: Henzel
authors.forename: E
authors.initials: E
authors.lastname: Delaporte
authors.forename: S
authors.initials: S
authors.lastname: Badiane
authors.forename: I
authors.initials: I
authors.lastname: N'Doye
authors.forename: J P
authors.initials: JP
authors.lastname: Coulaud
authors.forename: B
authors.initials: B
authors.lastname: Larouzé
authors.forename: O
authors.initials: O
authors.lastname: Bouchaud
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D005434:Flow Cytometry / Q000592:standards; D006801:Humans; D008297:Male; D018579:Patient Selection; D012680:Sensitivity and Specificity; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination