Grey nails predict low CD4 cell count among untreated patients with HIV infection in Malawi.
BACKGROUND
Alternative criteria for initiating antiretroviral therapy to CD4 testing or clinical illness are needed in Malawi.


METHODS
We tested if grey nails could be used to identify patients with a CD4 cell count less than 200 cells/microl who had not yet presented with AIDS-defining illnesses.


RESULTS
Using a set of 242 photographs we showed good inter-observer agreement for grey nails (kappa = 0.66; P < 0.0001) and the positive predictive value of grey nails for a CD4 cell count of less than 200 cells/microl was 81% (chi < 0.0001).


CONCLUSIONS
Grey nails have been associated with HIV infection and we have shown significant correlation of this sign with a low CD4 cell count. For clinicians working in sub-Saharan Africa without access to CD4 cell count testing, grey or DB nails represent an additional staging sign to help identify a sub-group of patients likely to benefit from ART.
Scarborough
Matthew
M
Department of Medicine, University of Malawi College of Medicine, Blantyre. mattscar@talktalk.net
Gordon
Stephen B
SB
French
Neil
N
Phiri
Chimota
C
Musaya
Janelisa
J
Zijlstra
Eduard E
EE
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009260:Nail Diseases / Q000175:diagnosis / Q000821:virology*; D015588:Observer Variation; D018579:Patient Selection; D010781:Photography; D010859:Pigmentation Disorders / Q000175:diagnosis / Q000821:virology*; D011237:Predictive Value of Tests
D019380:Anti-HIV Agents