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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults
Tropical Medicine and International Health, Volume 15, No. 2, Year 2010
Notification
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Description
Objectives To evaluate the use of grey/distal banded nails as an indicator of advanced immunosuppression, and thus eligibility for ART, in resource poor settings. Methods We tested whether grey/distal banded nails and/or oral pigmentation could be used to identify patients with low CD4 cell counts at two cut-offs: <200 and <350 cells/μl in ART naive adults. Results Four hundred and three nail and oral cavities were photographed and assessed. Grey/distal banded nails and/or oral pigmentation were significantly associated with a CD4 cell count <200 cells/μl (P < 0.001), with a sensitivity of 66%, a specificity of 50% and a negative predictive value of 77%. However, there was no association when a CD4 cell count cut-off of <350 cells/μl was used. Inter-observer agreement (k 0.46) was fair/moderate. Conclusions While grey/distal banded nails and/or oral pigmentation are associated with low CD4 counts, the sensitivity and kappa score are too low for this method to be recommended as a tool to guide ART initiation; large number of individuals eligible for ART would be missed. © 2010 Blackwell Publishing Ltd.
Authors & Co-Authors
Namakoola, Ivan
Uganda
Mrc/uvri Research Unit on Aids
Wakeham, Katie
Uganda
Mrc/uvri Research Unit on Aids
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Parkes-Ratanshi, Rosalind M.
Uganda
Mrc/uvri Research Unit on Aids
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
United Kingdom, London
Imperial College London
Levin, Jonathan B.
Uganda
Mrc/uvri Research Unit on Aids
South Africa, Johannesburg
Wits School of Public Health
Mugagga, T.
Unknown Affiliation
Seymour, C.
United Kingdom, London
Imperial College London
Kissa, John
Uganda
Mrc/uvri Research Unit on Aids
Kamali, Anatoli
Uganda
Mrc/uvri Research Unit on Aids
Lalloo, David G.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Statistics
Citations: 10
Authors: 9
Affiliations: 4
Identifiers
Doi:
10.1111/j.1365-3156.2009.02448.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Infectious Diseases