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

Namakoola, I., Wakeham, K., Parkes-Ratanshi, R., Levin, J., Mugagga, T., Seymour, C., Kissa, J.., Kamali, A. and Lalloo, D. G. (2010) Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults. Tropical Medicine and International Health, 15(2), pp. 259-262. (doi:10.1111/j.1365-3156.2009.02448.x)

Full text not currently available from Enlighten.

Publisher's URL: http://dx.doi.org/10.1111/j.1365-3156.2009.02448.x

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/μl 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/μl (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/μl 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:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wakeham, Dr Katie
Authors: Namakoola, I., Wakeham, K., Parkes-Ratanshi, R., Levin, J., Mugagga, T., Seymour, C., Kissa, J.., Kamali, A., and Lalloo, D. G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:Tropical Medicine and International Health
Journal Abbr.:Trop Med Int Health
Publisher:Wiley
ISSN:1360-2276
ISSN (Online):1365-3156
Related URLs:

University Staff: Request a correction | Enlighten Editors: Update this record