title: Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults.
abstract: 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.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. ivannamakoola@mrcuganda.org
authors.forename: I
authors.initials: I
authors.lastname: Namakoola
authors.forename: K
authors.initials: K
authors.lastname: Wakeham
authors.forename: R
authors.initials: R
authors.lastname: Parkes-Ratanshi
authors.forename: J
authors.initials: J
authors.lastname: Levin
authors.forename: T
authors.initials: T
authors.lastname: Mugagga
authors.forename: C
authors.initials: C
authors.lastname: Seymour
authors.forename: J
authors.initials: J
authors.lastname: Kissa
authors.forename: A
authors.initials: A
authors.lastname: Kamali
authors.forename: D G
authors.initials: DG
authors.lastname: Lalloo
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents