Evaluation of affordable screening markers to detect CD4+ T‐cell counts below 200 cells/μl among HIV‐1‐infected Ugandan adults

Objective To evaluate validity of WHO staging, low body mass index (BMI) and anaemia in detecting HIV‐infected adults with CD4+ T‐cell counts < 200 cells/μl. Methods Between October 1995 and April 2006, we screened Ugandans aged 16 or older at enrolment into an open cohort. We analysed highly active anti‐retroviral therapy (HAART)‐naïve HIV‐infected patients with WHO stages 1–3 and complete data in a secondary cross‐sectional study. Low BMI was a BMI < 18.5 kg/m². Anaemia was a haemoglobin level < 11 or 12 g/dl among women and men respectively. Results Among 2892 HAART‐naïve patients, the median age was 32 years. 71% were women, 54% had WHO stage 3 AIDS, 34% had anaemia, 16% had a low BMI and 43% had CD4+ T‐cell counts < 200 cells/μl. WHO stage 3 compared to combined WHO stages 1 and 2 had a sensitivity (95% CI) of 70% (67, 72) and a specificity of 57% (55, 60) respectively to detect CD4+ T‐cell counts < 200 cells/μl. Anaemia compared to normal haemoglobin had sensitivity (95% CI) of 47% (44, 50) and a specificity of 76% (74, 78). Low BMI compared to normal BMI had sensitivity (95% CI) of 23% (20, 25) and a specificity of 89% (87, 90) against CD4+ T‐cell counts < 200 cells/μl. Conclusion Only WHO stage 3 had reasonably high sensitivity in detecting CD4+ T‐cell counts below 200 cells/μl in this setting. Targeted low‐cost CD4 testing strategies are urgently needed to detect patients eligible for HAART in rural Africa and other resource‐limited settings.