title: Targeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi.
abstract: Malawi offers antiretroviral treatment (ART) to all HIV-positive adults who are clinically classified as being in WHO clinical stage III or IV without 'universal' CD4 testing. This study was conducted among such adults attending a rural district hospital HIV/AIDS clinic (a) to determine the proportion who have CD4 counts >or=350 cells/microl, (b) to identify risk factors associated with such CD4 counts and (c) to assess the validity and predictive values of possible clinical markers for CD4 counts >or=350 cells/microl. A CD4 count >or=350 cells/microl was found in 36 (9%) of 401 individuals who are thus at risk of being placed prematurely on ART. A body mass index (BMI) >22 kg/m(2), the absence of an active WHO indicator disease at the time of presentation for ART, and a total lymphocyte count >1,200 cells/microl were significantly associated with such a CD4 count. The first two of these variables could serve as clinical markers for selecting subgroups of patients who should undergo CD4 testing. In a resource-limited district setting, assessing the BMI and checking for active opportunistic infections are routine clinical procedures that could be used to target CD4 measurements, thereby minimising unnecessary CD4 measurements, unnecessary (too early) treatment and costs.
authors.affiliation: Médecins sans Frontières, Medical Department (Operational Research HIV-TB), Brussels Operational Center, 94 Rue Dupre, Brussels, Belgium. zachariah@internet.lu
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.forename: R
authors.initials: R
authors.lastname: Teck
authors.forename: O
authors.initials: O
authors.lastname: Ascurra
authors.forename: P
authors.initials: P
authors.lastname: Humblet
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000191:economics; D015992:Body Mass Index; D015704:CD4 Antigens / Q000276:immunology*; D018791:CD4 Lymphocyte Count; D003365:Costs and Cost Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D006679:HIV Seropositivity / Q000191:economics / Q000276:immunology*; D006300:Health Services Misuse; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents; D015704:CD4 Antigens