DIAGNOSIS AND SCREENING OF HIV AIDS USING CLINICAL-CRITERIA IN TANZANIAN ADULTS

The clinical utility of the World Health Organization (WHO) clinical c ase definition (CCD) of acquired immune deficiency syndrome (AIDS) in Africa, several proposed modifications of the WHO CCD, and two propose d screening algorithms for human immunodeficiency virus (HIV) infectio n were examined in adult medical inpatients in Dar es Salaam, Tanzania . Sensitivity, specificity, and positive and negative predictive value s were determined for the CCDs and screening algorithms. Multivariable analysis identified factors with high accuracy for HIV infection. Of 223 patients enrolled in the study, 95 were seropositive for HIV infec tion. The WHO CCD and the modified CCDs had low sensitivities (14.7-32 .6%) but high specificities (95.3-99.2%) and positive predictive value s (83.8-94.7%) The screening algorithms had moderate sensitivities (66 .3-77.9%) and poor specificities (46.1-79.7%). Multivariable analysis consistently identified oral candidiasis and lymphadenopathy as the be st predictors of HIV infection. Although patients with asymptomatic or early HIV infection may be missed by clinical criteria, in a high pre valence population, AIDS may be diagnosed accurately clinically becaus e of the effect of prevalence on the positive predictive values of the CCDs. Furthermore, selection of patients for HIV serologic testing ma y be guided by simple combinations of clinical features.