Use of nail and oral pigmentation to determine ART eligibility among HIV‐infected Ugandan adults |
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| Authors: | I. Namakoola K. Wakeham R. Parkes‐Ratanshi J. Levin T. Mugagga C. Seymour J. Kissa A. Kamali D. G. Lalloo |
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| Affiliation: | 1. MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda;2. Authors IN and KW contributed equally to the writing of this article.;3. Liverpool School of Tropical Medicine, Liverpool, UK;4. Imperial College London, London, UK;5. School of Public Health, University of the Witwatersrand, Witwatersrand, South Africa;6. The AIDS Support Organisation (TASO), Entebbe, Uganda;7. Imperial College London, London, UK;8. Liverpool School of Tropical Medicine, Liverpool, UK |
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| Abstract: | Objectives To evaluate the use of grey/distal banded nails as an indicator of advanced immunosuppression, and thus eligibility for ART, in resource poor settings. Methods We tested whether grey/distal banded nails and/or oral pigmentation could be used to identify patients with low CD4 cell counts at two cut‐offs: <200 and <350 cells/μl in ART naive adults. Results Four hundred and three nail and oral cavities were photographed and assessed. Grey/distal banded nails and/or oral pigmentation were significantly associated with a CD4 cell count <200 cells/μl (P < 0.001), with a sensitivity of 66%, a specificity of 50% and a negative predictive value of 77%. However, there was no association when a CD4 cell count cut‐off of <350 cells/μl was used. Inter‐observer agreement (k 0.46) was fair/moderate. Conclusions While grey/distal banded nails and/or oral pigmentation are associated with low CD4 counts, the sensitivity and kappa score are too low for this method to be recommended as a tool to guide ART initiation; large number of individuals eligible for ART would be missed. |
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| Keywords: | HIV‐1 nails clinical staging antiretroviral therapy AIDS VIH‐1 ongles stade clinique ART SIDA VIH‐1 uñ as estadí o clí nico TAR SIDA |
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