SAMJ: South African Medical Journal
On-line version ISSN 2078-5135
NZOU, Chidzewere et al. Clinical predictors of low CD4 count among HIV-infected pulmonary tuberculosis clients: a health facility-based survey. SAMJ, S. Afr. med. j. [online]. 2010, vol.100, n.9, pp. 602-605. ISSN 2078-5135.
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.