Relationship between clinical conditions and CD4 counts in HIV-infected persons in Pune, Maharashtra, India

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.