Correlation of WHO clinical staging with CD4 counts in adult HIV/AIDS patients at Kenyatta National Hospital, Nairobi.

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.

Setting: Kenyatta National Hospital, Nairobi.

Subjects: One hundread and fifty two newly diagnosed HIV patients were recruited prospectively. Patients were first staged using the 2005 WHO clinical staging and then blood drawn for CD4 cell count.

Results: The mean age in the study was 35 years, with females comprising 52.6% 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 > 350 cells/microl was 63% with a specificity of 82%. The most common 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/microl.