title: Screening HIV-infected adults in Malawi for anaemia: impact on eligibility for antiretroviral therapy.
abstract: Clinical staging determines antiretroviral therapy (ART) eligibility when CD4 count is not available. Haemoglobin (Hb) ≤8 g/dL is an indication for the treatment. We measured Hb in HIV-positive Malawian adults undergoing clinical assessment for ART eligibility and calculated the percentage of patients with CD4 ≤ 350 cells/μL deemed eligible for ART by clinical staging with and without Hb measurement, using the existing threshold and an alternative proposed after comparing Hb values to CD4 counts. Three hundred and thirty-eight patients had CD4 counts measured and 226 (67%) had CD4 ≤ 350 cells/μL. Thirty-six (16%) patients with low CD4 count were eligible for ART by clinical assessment alone, 48 (21%) when Hb was also measured with a threshold of ≤8 g/dL and 74 (34%) with a threshold of ≤10 g/dL. Measuring Hb alongside clinical assessment could increase the number of patients with CD4 ≤ 350 cells/μL starting ART by 33% using a threshold of Hb ≤ 8 g/dL or 114% with a threshold of ≤10g/dL.
authors: University of Manchester, Respiratory Research Group, 3rd floor ERC, Wythenshaw Hospital, Southmoor Road, Manchester M23 9LT, UK. iain.page@manchester.ac.uk
authors: I D
authors: ID
authors: Page
authors: S J
authors: SJ
authors: McKew
authors: A G
authors: AG
authors: Kudzala
authors: C
authors: C
authors: Fullwood
authors: J J
authors: JJ
authors: van Oosterhout
authors: I
authors: I
authors: Bates
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications* / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004608:Eligibility Determination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D006454:Hemoglobins
keywords: AIDS; Africa; CD4 count; HIV; Malawi; anaemia; antiretroviral therapy; clinical staging; eligibility; haemoglobin; resource-poor areas; treatment; treatment threshold
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