Clinical predictors of low CD4 count among HIV-infected pulmonary tuberculosis clients: A health facility-based survey
Abstract
Objectives. The study aimed to determine the clinical and laboratory predictors of a low CD4+ cell count (<200 cells/μl) in HIV-infected patients with pulmonary tuberculosis (PTB). Design and setting. A prospective cohort study on HIV-positive patients with smear-positive PTB attending an outpatient clinic in Zimbabwe. Participants. Consecutively consenting HIV-positive adults, aged 18 years and over, who had positive sputum smears for acid-fast bacilli and were naïve to both antituberculosis drugs and ART. Interventions. Baseline CD4+ cell count, full blood count, functional status using the Karnofsky Performance Status (KPS) score and body mass index (BMI, kg/m2) were determined for all participants. Univariate and multiple logistic regression analyses of the data were done. Results. Of the 97 participants recruited, 59 (61%) were females. The overall mean age was 34 years (standard deviation (SD) 8). The median CD4+ cell count was 104.5 cells/μl (intraquartile range (IQR) 41 - 213 cells/μl). Patients with pleuritic chest pain were less likely to have a low CD4+ cell count than patients who did not (odds ratio (OR) 0.2; confidence interval (CI) 0.03 - 0.8). The following were statistically significant predictors of a CD4+ cell count of <200 cells/ μl: BMI <18 kg/m2 (OR 3.8; CI 1.2 - 12), KPS <54.4 (OR 3; CI 1.1 - 12) and haemoglobin concentration <8 g/dl (OR 13; CI 1.8 - 533). Conclusions. HIV-infected sputum-positive PTB patients presenting with a BMI <18, KPS <54.4% and haemoglobin concentration <8 g/dl should have early initiation of ART since they are more likely to have a low CD4+ cell count, whereas those presenting with pleuritic pain are less likely to have a low CD4+ cell count.Copyright remains in the Author’s name. The work is licensed under a Creative Commons Attribution - Noncommercial Works License. Authors are required to complete and sign an Author Agreement form that outlines Author and Publisher rights and terms of publication. The Agreement form should be uploaded along with other submissions files and any submission will be considered incomplete without it [forthcoming].
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