CD4 validation for the World Health Organization classification and clinical staging of HIV/AIDS in a developing country

Objectives: To validate the World Health Organization (WHO) clinical staging and classification of HIV/AIDS using CD4+ T-lymphocyte counts in the setting of a developing country. Methods: This was a retrospective chart review of HIV-infected adults at the national HIV referral clinic in the Kingdom of Saudi Arabia. Four hundred HIV-infected individuals were reviewed. All individuals under the age of 15 years and those who had received antiretroviral therapy were excluded. WHO clinical stage at presentation was determined by a single reviewer. The first CD4+ T-lymphocyte count within 6 months of diagnosis of HIV infection was then abstracted by a different reviewer. The main outcome measure was the comparison of the WHO clinical stages of HIV/AIDS at the time of diagnosis and the CD4+ T-lymphocyte counts. Results: Data were available for 191 individuals, of whom 123 were men and 68 were women. The mean CD4+ T-lymphocyte count was 281/mm(3) in the men and 425/mm(3) in the women. The distribution of individuals at the WHO clinical stages was 110 at stage I, 10 at stage II, 36 at stage III, and 35 at stage IV. Mean CD4+ T-lymphocyte counts were 457, 337, 188, and 86/mm(3) at the respective stages. The difference between the mean CD4+ T-lymphocyte count in patients at stage IV and at each of the other stages was significant; p < 0.0001. The correlation between the stages and the mean CD4+ T-lymphocyte counts was -0.65. Conclusion: The WHO clinical staging and classification of HIV/AIDS correlates well with CD4+ T-lymphocyte counts. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.