Clinical predictors of low CD4 count among HIV infected pulmonary tuberculosis clients: a health facility-based survey.
OBJECTIVE
The study aimed to determine the clinical and laboratory predictors of a low CD4+ cell count (<200 cells/microl) in HIV-infected patients with pulmonary tuberculosis (PTB).


METHODS
A prospective cohort study on HIV-positive patients with smear-positive PTB attending an outpatient clinic in Zimbabwe.


METHODS
Consecutively consenting HIV-positive adults, aged 18 years and over, who had positive sputum smears for acid-fast bacilli and were naïve to both antituberculosis drugs and ART.


METHODS
Baseline CD4+ cell count, full blood count, functional status using the Karnofsky Performance Status (KPS) score and body mass index (BMI, kg/m2) were determined for all participants. Univariate and multiple logistic regression analyses of the data were done.


RESULTS
Of the 97 participants recruited, 59 (61%) were females. The overall mean age was 34 years (standard deviation (SD) 8). The median CD4+ cell count was 104.5 cells/microl (intraquartile range (IQR) 41-213 cells/microl). Patients with pleuritic chest pain were less likely to have a low CD4+ cell count than patients who did not (odds ratio (OR) 0.2; confidence interval (CI) 0.03-0.8). The following were statistically significant predictors of a CD4+ cell count of <200 cells /microl: BMI<18 kg/m2 (OR 3.8; CI 1.2-12), KPS<54.4 (OR 3; CI 1.1-12) and haemoglobin concentration<8 g/dl (OR 13; CI 1.8 - 533).


CONCLUSIONS
HIV-infected sputum-positive PTB patients presenting with a BMI<18, KPS<54.4% and haemoglobin concentration<8 g/dl should have early initiation of ART since they are more likely to have a low CD4+ cell count, whereas those presenting with pleuritic pain are less likely to have a low CD4+ cell count.
Nzou
Chidzewere
C
Clinical Epidemiology Resource Training Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Kambarami
Rose A
RA
Onyango
Francis E
FE
Ndhlovu
Chiratidzo E
CE
Chikwasha
Vasco
V
D000328:Adult; D000740:Anemia / Q000150:complications; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis* / Q000276:immunology; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012514:Sarcoma, Kaposi / Q000150:complications*; D013851:Thinness / Q000150:complications*; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000276:immunology; D015431:Weight Loss
D006454:Hemoglobins