WHO clinical criteria-based initiation of antiretroviral therapy: lessons from rural district hospitals in Cameroon with regard to 2009 revised WHO recommendations.
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.
Kouanfack
Charles
C
Central Hospital, Yaoundé, Cameroon.
Laborde-Balen
Gabrièle
G
Aghokeng
Avelin F
AF
Bourgeois
Anke
A
Dontsop
Marlise
M
Mben
Jean-Marc
JM
Kazé
Serge
S
Mpoudi-Ngolé
Eitel
E
Koulla-Shiro
Sinata
S
Delaporte
Eric
E
Laurent
Christian
C
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
D044966:Anti-Retroviral Agents; D015415:Biomarkers