title: The added value of a CD4 count to identify patients eligible for highly active antiretroviral therapy among HIV-positive adults in Cambodia.
abstract: In a retrospective study of 648 persons with HIV infection in Cambodia, we determined the sensitivity, specificity, and accuracy of the 2003 World Health Organization (WHO) criteria to start antiretroviral treatment based on clinical criteria alone or based on a combination of clinical symptoms and the total lymphocyte count. As a reference test, we used the 2003 WHO criteria, including the CD4 count. The 2003 WHO clinical criteria had a sensitivity of 96%, a specificity of 57%, and an accuracy of 89% to identify patients who need highly active antiretroviral therapy (HAART). In our clinic, with a predominance of patients with advanced disease, the 2003 WHO clinical criteria alone was a good predictor of those needing HAART. A total lymphocyte count as an extra criterion did not improve the accuracy. Nine percent of patients were wrongly identified to be in need of HAART. Among them, almost 50% had a CD4 count of more than 500 cells/muL, and 73% had weight loss of more than 10% as a stage-defining condition. Our data suggest that, in settings with limited access to CD4 count testing, it might be useful to target this test to patients in WHO stage 3 whose staging is based on weight loss alone, to avoid unnecessary treatment.
authors: Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
authors: Lut
authors: L
authors: Lynen
authors: Sopheak
authors: S
authors: Thai
authors: Paul
authors: P
authors: De Munter
authors: Bunse
authors: B
authors: Leang
authors: An
authors: A
authors: Sokkab
authors: Ward
authors: W
authors: Schrooten
authors: Veerle
authors: V
authors: Huyst
authors: Luc
authors: L
authors: Kestens
authors: Gary
authors: G
authors: Jacques
authors: Robert
authors: R
authors: Colebunders
authors: Joris
authors: J
authors: Menten
authors: Jef
authors: J
authors: van den Ende