A proposal for basic management of HIV disease in West Africa: use of clinical staging and haemogram data

Summary: Our objective was to propose a strategy to screen HIV infected African people for biological immunodeficiency easily. In a cross sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV infected adults. Peripheral facial paralysis and chronic cutaneo mucous diseases were the earlier B stage diseases. Pulmonary tuberculosis was close to B stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C stage symptom 47.8 . Ninety per cent of CDC C stage people had CD4 counts below 350 mul, whereas only 75 had CD4 counts below 200 mul. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350 mul. A simple score lymphocyte count 2500 mul and clinical stage B is proposed to determine this CD4 threshold positive predictive value: 83 and to determine those patients needing treatment to prevent wasting and opportunistic infections.