A simple clinical and paraclinical score predictive of CD4 cell counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal
Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 96, No. 2, Year 2002
Notification
URL copied to clipboard!
In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index <22 (+2), herpes zoster (+4), tuberculin induration <5 mm (+3) and haemoglobin ≤10 g/dL (+1). A score of ≥4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis.