title: WHO clinical criteria-based initiation of antiretroviral therapy: lessons from rural district hospitals in Cameroon with regard to 2009 revised WHO recommendations.
abstract: OBJECTIVE
  To assess the proportion of patients infected with HIV with a CD4 count above 350 cells/mm(3) among those classified at WHO clinical stage 3 or 4 who initiated antiretroviral therapy in rural district hospitals in Cameroon to assess the 2009 revised WHO recommendations.
  
  
  METHODS
  Cross-sectional study in nine rural district hospitals where the treatment initiation is based on the WHO clinical criteria. The proportion of patients who were classified at stage 3 or 4 and who had a CD4 count >350 cells/mm(3) was assessed.
  
  
  RESULTS
  Of 458 patients included in 2006-2008 (women 70.5%; median age 37.0 years), 337 (73.6%) were classified at WHO clinical stage 3 and 121 (26.4%) at stage 4. Overall, 108 patients (23.6%) had a CD4 count >350 cells/mm(3). Of them, 94 patients (20.5%) were classified at WHO clinical stage 3, and 14 (3.1%) were classified at WHO clinical stage 4.
  
  
  CONCLUSIONS
  The WHO clinical stages 3 and 4 were poorly correlated with the 'gold standard' of CD4 cell count. This study highlights the need to promote CD4 testing for assessing the patient eligibility.
authors.affiliation: Central Hospital, Yaoundé, Cameroon.
authors.forename: Charles
authors.initials: C
authors.lastname: Kouanfack
authors.forename: Gabrièle
authors.initials: G
authors.lastname: Laborde-Balen
authors.forename: Avelin F
authors.initials: AF
authors.lastname: Aghokeng
authors.forename: Anke
authors.initials: A
authors.lastname: Bourgeois
authors.forename: Marlise
authors.initials: M
authors.lastname: Dontsop
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Mben
authors.forename: Serge
authors.initials: S
authors.lastname: Kazé
authors.forename: Eitel
authors.initials: E
authors.lastname: Mpoudi-Ngolé
authors.forename: Sinata
authors.initials: S
authors.lastname: Koulla-Shiro
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.forename: Christian
authors.initials: C
authors.lastname: Laurent
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D002163:Cameroon; D003430:Cross-Sectional Studies; D003906:Developing Countries; D016903:Drug Monitoring; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy*; D006767:Hospitals, District; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D014944:World Health Organization
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers