Mv. Ghate et al., Relationship between clinical conditions and CD4 counts in HIV-infected persons in Pune, Maharashtra, India, NAT MED J I, 13(4), 2000, pp. 183-187
Background. A decade after the detection of human immunodeficiency virus (H
IV) infection in India, a steady increase in the number of patients with ac
quired immunodeficiency syndrome (AIDS) has been observed, The therapeutic
options for patients with AIDS in developing countries include chemoprophyl
axis and identifying and treating opportunistic infections. CD4 counts help
in clinical monitoring and making decisions about initiating antiretrovira
l therapy or chemoprophylaxis. Flowcytometry is expensive and available onl
y at specialized laboratories, Therefore, the possibility of using clinical
indicators to predict low CD4 counts and disease progression needs to be e
xplored.
Methods. This cross-sectional study was conducted among 137 HIV-infected pe
rsons investigated at an HIV reference centre in Pune, The study methods co
mprised pre-test counselling, informed consent, blood withdrawal and clinic
al evaluation. Serum samples were tested for HIV and CD4 counts were estima
ted on FACSort.
Results. Study participants commonly reported with oral candidiasis, herpes
tester, pulmonary tuberculosis, lymphadenopathy, weight loss, rash, diarrh
oea and fever. CD4 counts were significantly lower among men, symptomatic p
atients and those with oral candidiasis, weight loss and multiple clinical
conditions. The sensitivity of most of the clinical conditions was low, the
specificity was high and the positive predictive value of oral candidiasis
and weight loss for low CD4 counts was > 75%.
Conclusion. The presence of oral candidiasis and weight loss were highly pr
edictive of low CD4 counts and these can be considered as markers of HIV di
sease progression. Absence of clinical conditions was found to be a good pr
edictor of high CD4 counts. Larger systematic natural history studies may h
elp in identifying clinical conditions that could have a prognostic signifi
cance among HIV-infected people.