title: Clinical predictors cannot replace biological predictors in HIV-2 infection in a community setting in West Africa.
abstract: OBJECTIVE
  To identify clinical predictors of mortality in HIV-2-infected individuals that may be used in place of CD4 count or plasma viral load (PVL) to guide treatment management in resource-limited settings.
  
  
  METHODS
  A prospective community cohort study of HIV-infected and HIV-negative individuals in a rural area of Guinea-Bissau has been ongoing since 1989. In 2003 participants were invited for a clinical examination and blood tests. They were followed-up for vital status until 2010. Antiretroviral treatment (ART) became available in 2007. Cox regression was used to examine the association of clinical measures (World Health Organization (WHO) stage, body mass index (BMI), mid-upper arm circumference (MUAC), and WHO performance scale) measured in 2003 with subsequent mortality.
  
  
  RESULTS
  In 2003, 146 HIV-2-infected individuals (68% women; mean age 56 years) were examined. Over the next 7 years, 44 (30%) died. BMI<18.5kg/m(2) was associated with a crude mortality hazard ratio (HR) of 1.9 (95% confidence interval (CI) 1.0-3.9, p=0.08); adjusted for age and sex, HR 1.8 (95% CI 0.9-3.8, p=0.1). MUAC <230mm in women and <240mm in men was also associated with an elevated mortality HR, though statistical evidence was weak (crude HR 2.2, 95% CI 0.9-5.3, p=0.1). WHO clinical stage and WHO performance scale were not associated with mortality (p=0.6 and p=0.2, respectively, for crude associations).
  
  
  CONCLUSIONS
  Baseline BMI, MUAC, WHO stage, and WHO performance scale were not strong or statistically significant predictors of mortality among HIV-2-infected individuals. CD4 count and PVL are more reliable tools, when available, for the management of HIV-2-infected patients in the community setting.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. annabelle.gourlay@lshtm.ac.uk
authors.forename: Annabelle J
authors.initials: AJ
authors.lastname: Gourlay
authors.forename: Carla
authors.initials: C
authors.lastname: van Tienen
authors.forename: Sangeeta S
authors.initials: SS
authors.lastname: Dave
authors.forename: Tim
authors.initials: T
authors.lastname: Vincent
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Rowland-Jones
authors.forename: Judith R
authors.initials: JR
authors.lastname: Glynn
authors.forename: Hilton C
authors.initials: HC
authors.lastname: Whittle
authors.forename: Maarten F Schim
authors.initials: MF
authors.lastname: van der Loeff
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006169:Guinea-Bissau / Q000453:epidemiology; D015658:HIV Infections / Q000097:blood / Q000401:mortality* / Q000821:virology; D015498:HIV-2; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012424:Rural Population; D019562:Viral Load; D055815:Young Adult