Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults.
OBJECTIVE
To evaluate the use of grey/distal banded nails as an indicator of advanced immunosuppression, and thus eligibility for ART, in resource poor settings.


METHODS
We tested whether grey/distal banded nails and/or oral pigmentation could be used to identify patients with low CD4 cell counts at two cut-offs: <200 and <350 cells/microl in ART naive adults.


RESULTS
Four hundred and three nail and oral cavities were photographed and assessed. Grey/distal banded nails and/or oral pigmentation were significantly associated with a CD4 cell count <200 cells/microl (P < 0.001), with a sensitivity of 66%, a specificity of 50% and a negative predictive value of 77%. However, there was no association when a CD4 cell count cut-off of <350 cells/microl was used. Inter-observer agreement (k 0.46) was fair/moderate.


CONCLUSIONS
While grey/distal banded nails and/or oral pigmentation are associated with low CD4 counts, the sensitivity and kappa score are too low for this method to be recommended as a tool to guide ART initiation; large number of individuals eligible for ART would be missed.
Namakoola
I
I
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. ivannamakoola@mrcuganda.org
Wakeham
K
K
Parkes-Ratanshi
R
R
Levin
J
J
Mugagga
T
T
Seymour
C
C
Kissa
J
J
Kamali
A
A
Lalloo
D G
DG
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D017495:Hyperpigmentation / Q000276:immunology / Q000473:pathology / Q000821:virology*; D007108:Immune Tolerance; D008297:Male; D009059:Mouth Diseases / Q000276:immunology / Q000473:pathology / Q000821:virology*; D009061:Mouth Mucosa / Q000473:pathology; D009260:Nail Diseases / Q000276:immunology / Q000473:pathology / Q000821:virology*; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D019380:Anti-HIV Agents