Clinical Predictors of Low CD4 Count Among Hiv-Infected Pulmonary Tuberculosis Clients: A Health Facility-Based Survey (Original Articles) (Survey)
Tuberculosis (TB) remains one of the most important opportunistic infections among HIV-infected patients. Diagnosing pulmonary TB (PTB) has become problematic because HIV-positive patients tend to be smear negative and smear microscopy is the first line of diagnosis in people suspected to have TB. (1) It is estimated that more than 50% of HIV-infected patients will develop TB in their lifetime, and the annual risk of developing TB if HIV infected is 10%.2 Various studies have shown high mortality rates in HIV-infected TB patients in resource-limited settings. (2) HIV infection increases the risk of acquiring TB, alters the clinical presentation of TB and reduces overall survival. (3,4) High mortality rates in these patients have been attributed to severe immunosuppression as measured by CD4+ cell count, and to lack of antiretroviral therapy (ART). (5) One of the major challenges in resource-limited settings is clinical identification of HIV-infected TB patients who have sufficiently low CD4+ cell counts to merit early initiation of ART without the aid of expensive and not readily available CD4+ cell count tests. Being able to predict who might have a low CD4+ cell count would assist in the prioritisation of TB patients for ART and thus prevent initiation of ART when it is not yet indicated, an important advantage given that ART is a lifelong commitment.