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Targeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi.

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dc.contributor Médecins sans Frontières, Medical Department (Operational Research HIV-TB), Brussels Operational Center, 94 Rue Dupre, Brussels, Belgium. zachariah@internet.lu
dc.creator Zachariah, R
dc.creator Teck, R
dc.creator Ascurra, O
dc.creator Humblet, P
dc.creator Harries, A D
dc.date 2006-01
dc.date.accessioned 2017-01-31T07:10:03Z
dc.date.available 2017-01-31T07:10:03Z
dc.identifier Targeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi. 2006, 100 (1):24-31 Trans. R. Soc. Trop. Med. Hyg.
dc.identifier 0035-9203
dc.identifier 16202436
dc.identifier 10.1016/j.trstmh.2005.06.018
dc.identifier http://hdl.handle.net/10144/18360
dc.identifier http://fieldresearch.msf.org/msf/handle/10144/18360
dc.identifier Transactions of the Royal Society of Tropical Medicine and Hygiene
dc.identifier.uri http://dspace.mediu.edu.my:8181/xmlui/handle/10144/18360
dc.description Malawi offers antiretroviral treatment (ART) to all HIV-positive adults who are clinically classified as being in WHO clinical stage III or IV without 'universal' CD4 testing. This study was conducted among such adults attending a rural district hospital HIV/AIDS clinic (a) to determine the proportion who have CD4 counts >or=350 cells/microl, (b) to identify risk factors associated with such CD4 counts and (c) to assess the validity and predictive values of possible clinical markers for CD4 counts >or=350 cells/microl. A CD4 count >or=350 cells/microl was found in 36 (9%) of 401 individuals who are thus at risk of being placed prematurely on ART. A body mass index (BMI) >22 kg/m(2), the absence of an active WHO indicator disease at the time of presentation for ART, and a total lymphocyte count >1,200 cells/microl were significantly associated with such a CD4 count. The first two of these variables could serve as clinical markers for selecting subgroups of patients who should undergo CD4 testing. In a resource-limited district setting, assessing the BMI and checking for active opportunistic infections are routine clinical procedures that could be used to target CD4 measurements, thereby minimising unnecessary CD4 measurements, unnecessary (too early) treatment and costs.
dc.language en
dc.publisher Elsevier
dc.relation http://www.sciencedirect.com/science/journal/00359203
dc.rights Archived on this site with the kind permission of Elsevier Ltd. and the Royal Society of Tropical Medicine and Hygiene, http://www.rstmh.org/transactions.asp
dc.title Targeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi.


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