Association between Clinical Stages (WHO) and CD4+T-Cell count in HIV infected adults at University Teaching Hospital in Lusaka,Zambia

Abstract

Infection with HIV ultimately results in profound immunodeficiency, in which patients may present with various AIDS – defining clinical conditions.The CD4+T-cell count is an important parameter to understand HIV-related opportunistic infections. In poor countries and populations with limited resources, WHO staging system may more useful than CDC classification system of HIV infection. This study was conducted to examine the relationship between WHO clinical stages and CD4+T-cell count in HIV-infected adults at UTH in Lusaka, Zambia. Selected HIV-infected Zambians adults attending UTH were examined and categorized in WHO clinical stages in a cross-sectional study. Blood was collected for CD4+T-cell count using the FACS method. Different models were developed for the distribution of CD4+T-cell count with other variables. The mean CD4+T-cell counts were estimated and compared between WHO clinical stages. We utilised Epi –Info 6 for descriptive and bi -variable analysis with linear regression for correlation.Of 216 HIV participants of the study, 107 (49.5%) were males and 109 (50.5%) females. The mean BMI was estimated at 21.2kg/m2 for the all study population and 44 (23.3%), 16 (8.5%), 83 (43.9%) and 46 (24.3%) subjects were in stage 1, 2, 3 and 4 respectively. Pulmonary tuberculosis (19%), severe bacterial infection (9.7%), weight loss > 10% (7.4%) and oral candidiasis (6.7%) were the commonest clinical conditions diagnosed among symptomatic participants.One hundred three (55.7 %) participants had CD4+T-cell count less than 200 and only 27 (14.6%) of them were in stage 4. Among all individuals of the study, 83 (43.9%) and 46 (24.3 %) were in stage 3 and 4 respectively.In conclusion, this hospital-based cross-sectional study showed a weak correlation between clinical stages of the WHO Staging system and the CD4 + T-Cell Count in adult Zambian HIV-infected patients at UTH. The majority of the patients observed were in stages 3 and 4, of the WHO Staging system and half of the study population had low CD4 +T-Cell Count (less than 200 cells/ul). A larger population-based study including asymptomatic patients with higher CD4 counts would be useful to confirm the findings of this study and help health authorities with formulation of policies and projection of costs of provision of lifelong treatment.