HIV This Week

Lynen L, Thai S, et al. The added value of a CD4 count to identify patients eligible for highly active antiretroviral therapy among HIV-positive adults in Cambodia. J Acquir Immune Defic Syndr. 2006 May 8; [Epub ahead of print]. http://gateway.ut.ovid.com/gw2/ovidweb.cgi

In a retrospective study of 648 persons with HIV infection in Cambodia, Lynen and colleagues determined the validity of the 2003 WHO criteria to start HAART based on clinical criteria alone or based on a combination of clinical symptoms and the total lymphocyte count. As a reference test, the authors used the 2003 WHO criteria, including the CD4 count. The 2003 WHO clinical criteria had a sensitivity of 96%, a specificity of 57%, and an accuracy of 89% in identifying patients in need of HAART. In their clinic, with a predominance of patients with advanced disease, the 2003 WHO clinical criteria alone were a good predictor of patients needing HAART. A total lymphocyte count as an extra criterion did not improve the accuracy. Nine percent of patients were wrongly identified to be in need of HAART. Among them, almost 50% had a CD4 count of more than 500 cells/ml, and 73% had weight loss of more than 10% as a stage-defining condition. The authors conclude that (according to their data), in settings with limited access to CD4 count testing, it might be useful to target this test to patients in WHO stage 3 whose staging is based on weight loss alone, to avoid unnecessary treatment.