Classification of HIV infection and disease in women from Rwanda. Evaluation of the World Health Organization HIV staging system and recommended modifications.
Ann Intern Med
; 122(4): 262-70, 1995 Feb 15.
Article
em En
| MEDLINE
| ID: mdl-7825761
ABSTRACT
PIP: In Rwanda, health workers followed 412 HIV infected women attending prenatal and pediatric outpatient clinics in Kigali for 4 years. Researchers used these findings to evaluate WHO's HIV Staging System and predictors of mortality and to produce an HIV staging system for sub-Saharan Africa. The 36-month cumulative mortality was 9% for women originally in stage I, 15% for those in stage II, and 25% for those in stage III, and 27% for those in stage IV (p = 0.001). Significant predictors of mortality at 36 months were oral candidiasis, a low body mass index (=or 19 kg/sq. m), a history of oral or genital ulcers (especially chronic ulcers), a low hematocrit (0.38), and a high erythrocyte sedimentation rate (65 mm/h) (p 0.001). 12 of the 96 women who died by 36 months had developed pulmonary or extrapulmonary tuberculosis (TB). The researchers revised the WHO system by adding oral candidiasis, chronic oral or genital ulcers, and pulmonary TB to clinical stage IV (severe HIV disease). In the laboratory axis of the system, they replaced lymphocyte count with hematocrit and erythrocyte sedimentation rate. Using the modified laboratory axis, the 36-month mortality rate was 10% for women with normal laboratory results (stage A) and 33% for those with low hematocrit and a high erythrocyte sedimentation rate (stage B). Based on the proposed single staging system, the 36-month mortality rate was 7% for women in stage I, 10% for those in stage II, 29% for those in stage III, and 62% for those in stage IV (p 0.001). The researchers used these results to propose a staging system that is relevant for sub-Saharan Africa, considers the extent of HIV-related outcomes, requires only inexpensive and available laboratory tests, and has clear prognostic significance. Both clinicians and researchers can use this modified staging system.
Palavras-chave
Africa; Africa South Of The Sahara; Cohort Analysis; Demographic Factors; Developing Countries; Diseases; Eastern Africa; Examinations And Diagnoses; French Speaking Africa; Hiv Infections; Hiv Serodiagnosis; International Agencies; Laboratory Examinations And Diagnoses; Methodological Studies; Mortality; Organizations; Physical Examinations And Diagnoses; Population; Population Dynamics; Prospective Studies; Research Report; Rwanda; Signs And Symptoms; Studies; Un; Viral Diseases; Who
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Países em Desenvolvimento
Tipo de estudo:
Diagnostic_studies
/
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
Limite:
Adolescent
/
Adult
/
Female
/
Humans
País/Região como assunto:
Africa
Idioma:
En
Ano de publicação:
1995
Tipo de documento:
Article