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Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults

Namakoola, I, Wakeham, Katie, Parkes-Ratanshi, Rosalind, Levin, J, Mugagga, T, Seymour, C, Kissa, J, Kamali, A and Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200 (2010) 'Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults'. Tropical Medicine & International Health, Vol 15, Issue 2, pp. 259-262.

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Abstract

objectives To evaluate the use of grey ⁄ distal banded nails as an indicator of advanced
immunosuppression, and thus eligibility for ART, in resource poor settings.
methods We tested whether grey ⁄ distal banded nails and ⁄ or oral pigmentation could be used to
identify patients with low CD4 cell counts at two cut-offs: <200 and <350 cells ⁄ ll in ART naive adults.
results Four hundred and three nail and oral cavities were photographed and assessed. Grey ⁄ distal
banded nails and ⁄ or oral pigmentation were significantly associated with a CD4 cell count <200 cells ⁄ ll
(P < 0.001), with a sensitivity of 66%, a specificity of 50% and a negative predictive value of 77%.
However, there was no association when a CD4 cell count cut-off of <350 cells ⁄ ll was used.
Inter-observer agreement (k 0.46) was fair ⁄ moderate.
conclusions While grey ⁄ distal banded nails and ⁄ or oral pigmentation are associated with low CD4
counts, the sensitivity and kappa score are too low for this method to be recommended as a tool to
guide ART initiation; large number of individuals eligible for ART would be missed.

Item Type: Article
Uncontrolled Keywords: HIV-1, nails, clinical staging, antiretroviral therapy, AIDS
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268.5 Antiviral agents (General)
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
Digital Object Identifer (DOI): https://doi.org/10.1111/j.1365-3156.2009.02448.x
Depositing User: Users 43 not found.
Date Deposited: 09 Jul 2010 10:32
Last Modified: 22 Feb 2018 15:58
URI: http://archive.lstmed.ac.uk/id/eprint/1042

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