Evaluation of two staging systems for HIV infection for use in developing countries

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Abstract

Objective:

To evaluate the clinical axis of the World Health Organization (WHO) clinical staging system and the modified WHO staging system proposed by Montaner et al. using the lymphocyte strata > 1500, 1500−1000 and < 1000 cells×106/l.

Design:

Cross-sectional study.

Patients:

Four hundred and fifteen consecutive patients with HIV infection attending three HIV reference centres in Belgium.

Methods:

Absolute CD4 lymphocyte counts were compared between stages within the two staging systems.

Results:

Median CD4 lymphocyte counts decreased with increasing stage of disease in both staging systems. Differences in median CD4 lymphocyte counts between stages of each staging system were statistically significant (Kruskal–Wallis one-way analysis of variance, P<0.001). The WHO clinical stage 1 and the modified WHO stage I had positive predictive values of 56 and 58%, respectively, for identifying patients with CD4 lymphocyte levels > 500 cells×106/l. The WHO clinical stage 4 and the modified WHO stage IV had positive predictive values of 79 and 80%, respectively, for identifying patients with CD4 lymphocyte levels < 200 cells×106/l.

Conclusions:

The WHO clinical staging system or a modified version of this system using lymphocytes stratification may be a good alternative in developing countries to the CD4 lymphocyte count-based HIV staging system used in the developed world. Cohort studies in developing countries are needed to assess their prognostic value.

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