WHO clinical staging of HIV infection and disease, tuberculosis and eligibility for antiretroviral treatment: relationship to CD4 lymphocyte counts.
METHODS
Thyolo district, Malawi.


OBJECTIVE
To determine in HIV-positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB).


METHODS
Cross-sectional study.


METHODS
CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV.


RESULTS
A CD4 lymphocyte count of < or = 350 cells/microl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease.


CONCLUSIONS
In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of < or = 350 cells/microl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy.
Teck
R
R
Médecins sans Frontières-Luxembourg, Thyolo, Malawi.
Ascurra
O
O
Gomani
P
P
Manzi
M
M
Pasulani
O
O
Kusamale
J
J
Salaniponi
F M L
FM
Humblet
P
P
Nunn
P
P
Scano
F
F
Harries
A D
AD
Zachariah
R
R
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D003430:Cross-Sectional Studies; D004608:Eligibility Determination / Q000379:methods*; D005260:Female; D015483:HIV Antibodies / Q000276:immunology; D015658:HIV Infections / Q000145:classification / Q000188:drug therapy / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology; D015498:HIV-2 / Q000276:immunology; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014376:Tuberculosis / Q000188:drug therapy / Q000276:immunology*; D014944:World Health Organization
D019380:Anti-HIV Agents; D015483:HIV Antibodies