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Published on: December 3, 2019
Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults
I Namakoola1, K Wakeham, R Parkes-Ratanshi
1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. ivannamakoola@mrcuganda.org
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/microl 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/microl (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/microl 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.
