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Updated: Jun 28, 2026
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
CD4 validation for the World Health Organization classification and clinical staging of HIV/AIDS in a developing
Jameela Edathodu1, Batool Ali, Abdulrahman A Alrajhi
1King Faisal Hospital and Research Centre, Thakassussi Street, Riyadh, Saudi Arabia. jameelaedathodu@yahoo.com
Insights
The World Health Organization (WHO) clinical staging for HIV/AIDS effectively correlates with CD4+ T-lymphocyte counts, validating its use in developing countries. This classification system aids in assessing disease progression and patient immune status.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- The World Health Organization (WHO) provides clinical staging for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS).
- Validating this staging system with objective immune markers like CD4+ T-lymphocyte counts is crucial, especially in resource-limited settings.
- Accurate staging impacts patient management and public health strategies for HIV/AIDS.
Purpose of the Study:
- To validate the WHO clinical staging and classification of HIV/AIDS.
- To assess the correlation between WHO clinical stages and CD4+ T-lymphocyte counts in a developing country context.
Main Methods:
- Retrospective chart review of 191 HIV-infected adults at a national referral clinic in Saudi Arabia.
- Exclusion of individuals under 15 years and those on antiretroviral therapy.
- Comparison of WHO clinical stage at diagnosis with the first CD4+ T-lymphocyte count within six months.
Main Results:
- A significant negative correlation (r=-0.65) was observed between WHO clinical stage and CD4+ T-lymphocyte counts.
- Mean CD4+ counts decreased progressively across WHO stages: Stage I (457/mm³), Stage II (337/mm³), Stage III (188/mm³), and Stage IV (86/mm³).
- The difference in mean CD4+ counts between Stage IV and all other stages was statistically significant (p<0.0001).
Conclusions:
- The WHO clinical staging system for HIV/AIDS demonstrates a strong correlation with CD4+ T-lymphocyte counts.
- This validation supports the utility of the WHO staging in assessing HIV/AIDS progression in developing countries.
- The findings reinforce the reliability of clinical assessment alongside immunological markers for HIV/AIDS management.
Objectives:
To validate the World Health Organization (WHO) clinical staging and classification of HIV/AIDS using CD4+ T-lymphocyte counts in the setting of a developing country.
Methods:
This was a retrospective chart review of HIV-infected adults at the national HIV referral clinic in the Kingdom of Saudi Arabia. Four hundred HIV-infected individuals were reviewed. All individuals under the age of 15 years and those who had received antiretroviral therapy were excluded. WHO clinical stage at presentation was determined by a single reviewer. The first CD4+ T-lymphocyte count within 6 months of diagnosis of HIV infection was then abstracted by a different reviewer. The main outcome measure was the comparison of the WHO clinical stages of HIV/AIDS at the time of diagnosis and the CD4+ T-lymphocyte counts.
Results:
Data were available for 191 individuals, of whom 123 were men and 68 were women. The mean CD4+ T-lymphocyte count was 281/mm(3) in the men and 425/mm(3) in the women. The distribution of individuals at the WHO clinical stages was 110 at stage I, 10 at stage II, 36 at stage III, and 35 at stage IV. Mean CD4+ T-lymphocyte counts were 457, 337, 188, and 86/mm(3) at the respective stages. The difference between the mean CD4+ T-lymphocyte count in patients at stage IV and at each of the other stages was significant; p<0.0001. The correlation between the stages and the mean CD4+ T-lymphocyte counts was -0.65.
Conclusion:
The WHO clinical staging and classification of HIV/AIDS correlates well with CD4+ T-lymphocyte counts.
