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Free Content Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults

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Abstract:

Summary 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 ( < 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 ( 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.

French
Objectifs: 

Evaluer l’utilisation de la pigmentation en bandes grises/distales des ongles comme un indicateur de l’immunosuppression avancée et pour l’éligibilitéà l’ART dans des régions pauvres. Méthodes: 

Nous avons testé si la pigmentation en bandes grises/distales des ongles et/ou orale pouvaient être utilisée pour identifier les patients avec un faible nombre de cellules CD4 à deux seuils: <200 cellules/μl et < 350 cellules/μl, chez les adultes non traités par ART. Résultats: 

403 ongles et cavités orales ont été photographiés et analysés. La pigmentation en bandes grises/distales des ongles et/ou orale était significativement associée à un taux de CD4 < 200 cellules/μl (p < 0,001), avec une sensibilité de 66%, une spécificité de 50% et une valeur prédictive négative de 77%. Toutefois, il n’y avait pas d’association quand le seuil de CD4 < 350 cellules/μl était utilisé. La concordance inter observateurs (k 0,46) était de bonne à moyenne. Conclusions: 

Bien que la pigmentation en bandes grises/distales des ongles et/ou orale soit associée à des taux de CD4 faibles, la sensibilité et le score kappa sont trop faibles pour que cette méthode soit recommandée comme un outil pour guider l’initiation à ART; un grand nombre de personnes éligibles pour l’ART serait raté.

Keywords: AIDS; ART; HIV-1; SIDA; TAR; VIH-1; antiretroviral therapy; clinical staging; estadío clínico; nails; ongles; stade clinique; uñas

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1365-3156.2009.02448.x

Affiliations: 1:  The AIDS Support Organisation (TASO), Entebbe, Uganda 2:  Imperial College London, London, UK 3:  MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda 4:  Liverpool School of Tropical Medicine, Liverpool, UK

Publication date: 2010-02-01

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