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Development of a clinical scoring system for assessment of immunosuppression in patients with tuberculosis and HIV infection without access to CD4 cell testing - results from a cross-sectional study in Ethiopia
Lund University, Sweden .
Lund University, Sweden Minist Heatlh, Ethiopia .
ORHB, Ethiopia .
Skåne University Hospital, Sweden .
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2014 (English)In: Global health action, ISSN 1654-9880, E-ISSN 1654-9880, Vol. 7, no 23105Article in journal (Refereed) Published
Abstract [en]

Background: Currently, antiretroviral therapy (ART) is recommended for all HIV-positive patients with tuberculosis (TB). The timing of ART during the course of anti-TB treatment is based on CD4 cell counts. Access to CD4 cell testing is not universally available; this constitutes an obstacle for the provision of ART in low-income countries. Objective: To determine clinical variables associated with HIV co-infection in TB patients and to identify correlations between clinical variables and CD4 cell strata in HIV/TB co-infected subjects, with the aim of developing a clinical scoring system for the assessment of immunosuppression. Design: Cross-sectional study of adults with TB (with and without HIV co-infection) recruited in Ethiopian outpatient clinics. Clinical variables potentially associated with immunosuppression were recorded using a structured questionnaire, and they were correlated to CD4 cell strata used to determine timing of ART initiation. Variables found to be significant in multivariate analysis were used to construct a scoring system. Results: Among 1,116 participants, the following findings were significantly more frequent in 307 HIV-positive patients compared to 809 HIV-negative subjects: diarrhea, odynophagia, conjunctival pallor, herpes zoster, oral candidiasis, skin rash, and mid-upper arm circumference (MUAC) less than20 cm. Among HIV-positive patients, conjunctival pallor, MUAC less than20 cm, dyspnea, oral hairy leukoplakia (OHL), oral candidiasis, and gingivitis were significantly associated with less than350 CD4 cells/mm(3). A scoring system based on these variables had a negative predictive value of 87% for excluding subjects with CD4 cell counts less than100 cells/mm(3); however, the positive predictive value for identifying such individuals was low (47%). Conclusions: Clinical variables correlate with CD4 cell strata in HIV-positive patients with TB. The clinical scoring system had adequate negative predictive value for excluding severe immunosuppression. Clinical scoring systems could be of use to categorize TB/HIV co-infected patients with regard to the timing of ART initiation in settings with limited access to laboratory facilities.

Place, publisher, year, edition, pages
Co-Action Publishing: Creative Commons Attribution / Co-Action Publishing , 2014. Vol. 7, no 23105
Keyword [en]
HIV; tuberculosis; Ethiopia; scoring system; CD4 cell; timing of ART
National Category
Microbiology in the medical area Clinical Medicine
URN: urn:nbn:se:liu:diva-105039DOI: 10.3402/gha.v7.23105ISI: 000331405300001OAI: diva2:703373
Available from: 2014-03-06 Created: 2014-03-06 Last updated: 2015-04-01

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Schön, Thomas
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Division of Microbiology and Molecular MedicineFaculty of Health Sciences
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