Correlation of WHO clinical staging with CD4 counts in adult HIV/AIDS patients at KNH

Abstract

OBJECTIVE: To determine the degree of correlation between the WHO clinical staging and CD4 T cell counts in HIV / AIDS adults at Kenyatta National Hospital, Nairobi.

DESIGN: Cross-sectional study.

SETIING: Kenyatta National Hospital, Nairobi.

SUBJECTS: 152 newly diagnosed HIV patients were recruited prospectively. Patients were first staged using the 2005 WHO clinical staging and then blood drawn for CD4 count.

RESULTS: The mean age in the study was 35 years, with females comprising 56.2% of the study group. The mean CD4 counts were 455, 420, 203 and 92 for WHO Stage 1, 2, 3 and 4 respectively. The sensitivity of the WHO clinical staging to predict CD4 counts of >350cells/lJl was 63% with a specificity of 82%. The commonest HIV clinical events were bacterial infections(33%), severe weight loss(28%) and tuberculosis(27%).

CONCLUSIONS: There was correlation between the WHO clinical staging and expected CD4 T cell count. However, the sensitivity was low and missed over a third of the patients in need of HAART. Majority of the patients presented in severe disease in need of HAART at the onset of their HIV diagnosis with 107 (70.3%) of the patients with Stage 3 or 4 disease and 114 (75%) of patients with CD4 counts of <350 cells/pl.

KEY WORDS: HIV, AIDS, CD4 counts, Kenyatta National Hospital, Nairobi