Regional differences in predictive accuracy of WHO immunologic failure criteria

We compared the performance of the WHO immunologic criteria for treatment failure among Uganda and American patients. Antiretroviral treatment-naive patients with a CD4 T-cell count less than 200 cells/μl or AIDS at enrollment on a nonnucleoside reverse transcriptase inhibitors-based regimen for more than 1 year were selected. For all criteria, the positive predictive value was significantly higher in the American compared with the Ugandan patients. Population-specific guidelines should be developed using large African cohorts to identify more specific and sensitive criteria.