Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers
E. Kassa et al., Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers, AIDS, 13(3), 1999, pp. 381-389
Objective: To study the association between the clinical axis of the World
Health Organization (WHO) staging system of HIV infection and disease and l
aboratory markers in HIV-infected Ethiopians.
Design: Cross-sectional study.
Methods: Clinical manifestations and stage of HIV-positive individuals part
icipating in a cohort study of HIV infection progression, and of HIV-positi
ve patients hospitalized with suspicion of AIDS, were compared to CD4+ T-ce
ll count and viral load.
Results: Of the 86 HIV-positive participants of the cohort study, 53 (62%),
16 (19%), 16(19%), and one (1.2%) were in stage 1, 2, 3 and 4, respectivel
y. Minor weight loss (n = 15) and pulmonary tuberculosis (n = 9) were the m
ost commonly diagnosed conditions among the 38 (44%) symptomatic HIV-positi
ve individuals. Although 23 (27%) HIV-positive participants had CD4+ T-cell
counts less than 200 x 10(6)/l, only one was in clinical stage 4. Among 79
hospitalized HIV-positive patients, 15 (19%) and 64 (81%) were in stage 3
and 4, respectively. The majority (83.5%) had CD4+ T-cell counts < 200 x 10
(6)/l. Individuals at stage 3 had lower CD4+ T-cell counts and higher viral
loads when seen in hospital as compared to cohort participants (P = 0.06 a
nd 0.008, respectively). When grouping the two study populations, the media
n CD4+ T-cell count decreased (337, 262, 225, 126, and 78 x 10(6)/l, P < 0.
01), and the median viral load increased (4.08, 3.89, 4.47, 5.65, and 5.65
log(10) copies/ml, P < 0.01), with increasing clinical stage of HIV infecti
on (1, 2, 3 cohort, 3 hospital, and 4, respectively). Median CD4+ T-cell co
unts were remarkably low in HIV-negative participants (749 x 10(6)/l), and
in HIV-positive participants at stage 1 and 2 (337 and 262 x 10(6)/l, respe
ctively).
Conclusions: There was a good correlation between WHO clinical stages and b
iological markers. CD4+ T-cell counts were low in Ethiopians, particularly
during early stages of HIV-1 infection, and preliminary reference values at
different stages of HIV-1 infection were determined. In HIV-infected Ethio
pians, lymphocyte counts less than 1,000 x 10(6)/l in non-hospitalized indi
viduals, and less than 2,000 x 10(6)/l in hospitalized patients, had high p
ositive predictive value, but low sensitivity, in identifying subjects with
low CD4+ T-cell counts (< 200 x 10(6)/l) who would benefit from chemoproph
ylaxis of opportunistic infections. The on-going longitudinal study will be
useful to confirm the prognostic value of the WHO staging system. (C) 1999
Lippincott Williams & Wilkins.