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S. Pathai, C. Gilbert, S. D. Lawn, A. Deshpande; Sensitivity and Specificity of Clinical Parameters and CD4 Count in Predicting HIV-Associated Eye Disease. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4853.
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To investigate the validity of clinical parameters and CD4 count in predicting HIV-associated eye disease within a cohort of HIV-infected ART [anti-retroviral therapy]-naive adults in Mumbai, India
A standardised symptom screen and ophthalmic examination were performed on consecutive patients fulfilling criteria for ART clinic enrolment, irrespective of the presence or absence of ocular/visual symptoms. Prevalence of HIV-eye disease was determined. Analyses ascertained the proportion of participants with HIV eye disease that would be detected if only subsets of higher risk (e.g. low CD4 count, visual impairment) were screened
Enrolled patients (n=149) had a median CD4 cell count of 180 cell/µL. The prevalence of HIV-associated eye disease was 17.5% (95%CI, 11.2-23.6) in all participants and 23.8% (95%CI: 14.5-33.1) in those with CD4 cell counts <200 cells/µL (n=84). The specificity of ocular symptoms in predicting HIV-ocular disease was high (92%, 95% CI: 86.1-96.3) the sensitivity and positive predictive value (PPV) were low (7.7%, 95%CI: 1.3-26.6 and 18%, 95%CI: 3.2-52.2, respectively). Using WHO clinical stage 3/4 as a screening subset for HIV eye disease gave a sensitivity of 92.3% (95%CI: 73.4-98.6) and specificity of 52.8% (95%CI: 43.7-61.8). There was no clear CD4 count threshold above which led to a marked increment in sensitivity. With decreasing CD4 counts specificity and PPV increased. The lowest number needed to screen (NNS) was found screening those with visual impairment (NNS 2.4, 95%CI: 1.4-6.0). Overall the NNS was lower the greater the degree of immunodeficiency
Our findings highlight the need for routine baseline ocular screening at the pre-ART stage. In particular the low sensitivity and PPV of ocular symptom screening in this population suggests utilising patients’ subjective description of ocular complaints is an unreliable method to detect HIV-associated eye disease. The results of our validity analyses suggest that ophthalmic screening examinations might be prioritised for subsets of patients with advanced immunodeficiency as manifested by WHO clinical status 3/4, and the presence of systemic TB.
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