AEGiS-15IAC: Clinical criteria only as compared to clinical-immunological criteria for initiating ART following the 2003 WHO guidelines in a Cambodian patient cohort.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Clinical criteria only as compared to clinical-immunological criteria for initiating ART following the 2003 WHO guidelines in a Cambodian patient cohort.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrB1081)

Chel S, Lim K, De Munter P, Lynen L, Thai S, Hines JG, Schrooten W
Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia

BACKGROUND: Guidelines recommend determining a CD4-lymphocyte count before initiation of antiretroviral therapy in PLWHA. CD4 counts are often not available. We evaluated the new criteria for start of ART as proposed in a draft document of WHO in a cohort of PLWHA in Sihanouk Hospital Center of HOPE (SHCH) in Phnom Penh.

METHODS: Data from PLWHA are in a Microsoft Access database. We anonymized all data and analysed the CD4 count and the WHO clinical stage (on the basis of registered clinical criteria or in the absence of this, as registered by the doctor on first evaluation) at the time of the first CD4 registered in the database. We calculated sensitivity and specificity of the clinical criteria as compared to combined clinical-immunological criteria. Approval of IRB in SHCH was obtained.

RESULTS: CD4 count is available for 339 out of 717 PLWHA in the database. The mean CD4 is 136 (range 1 to 999). 4 (1.2%) PLWHA are WHO stage 1, 49 (14.5%) stage 2, 121 (37.7%) stage 3 and 165 (48.7%) stage 4. 255 PLWHA had a CD4<200/mm³. 289 PLWHA fulfill the clinical-immunological criteria for ART (stage 3 with CD4<350, stage 4 or CD4<200). Of these 272 are stage 3 or 4, 17 are stage 2 giving a sensitivity of 94.1% (95% CI 90.8, 96.3) for clinical criteria alone. 50 PLWHA do not fulfill the clinical-immunological criteria: 14 are stage 3; 36 are stage 1 or 2, giving a specificity of clinical criteria of 72% (95% CI 58.3, 82.5). The positive predictive value of clinical criteria is 95.1%.

CONCLUSIONS: In our cohort sensitivity of clinical criteria alone to identify PLWHA in need for ART is 94.1%, which is explained by the late stage in which PLWHA present in Cambodia. At the cost of determining CD4 counts for the whole cohort, we would gain 5.9% asymptomatic PLWHA, who could start ART while still stable and before life-threatening opportunistic infections. In settings similar to this we should not wait for the availability of CD4 counts to identify patients who need ART.

Keywords: AEGIS, CD4 Lymphocyte Count, Guidelines, Sensitivity and Specificity, Cambodia, Humans, immunology, standards, epidemiology

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MoOrB1081