title: Grey nails predict low CD4 cell count among untreated patients with HIV infection in Malawi.
abstract: 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.
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre. mattscar@talktalk.net
authors.forename: Matthew
authors.initials: M
authors.lastname: Scarborough
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Gordon
authors.forename: Neil
authors.initials: N
authors.lastname: French
authors.forename: Chimota
authors.initials: C
authors.lastname: Phiri
authors.forename: Janelisa
authors.initials: J
authors.lastname: Musaya
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Zijlstra
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents