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Wakeham K.,MRC UVRI Uganda Research Unit on AIDS | Harding R.,Kings College London | Bamukama-Namakoola D.,MRC UVRI Uganda Research Unit on AIDS | Levin J.,MRC UVRI Uganda Research Unit on AIDS | And 6 more authors.
Journal of Palliative Medicine

Purpose: This study aimed to measure symptom burden prior to antiretroviral therapy (ART) initiation in a population of adults with low CD4 presenting for human immunodeficiency virus (HIV) care and treatment in Uganda, and to explore the relationship between World Health Organization (WHO) stage, CD4 count, and symptomatology. Methods: HIV-infected, ART-naïve adults with CD4 less than 200cells per microliter referred from voluntary testing and counseling services in rural Uganda for potential enrollment into a large double-blinded placebo-controlled trial were invited to completed the Memorial Symptom Assessment Scale-Short Form (MSAS-SF). This is a validated symptom assessment tool that records the presence and severity of 37 physical and 4 psychological symptoms. Results: Two hundred twelve subjects were enrolled. The mean total number of symptoms was 14.0 (standard deviation [SD] =6). The 10 most common symptoms were pain (76%), weight loss (70%), itching (67%), feeling drowsy/tired (61%), and lack of energy (61%), numbness /tingling in hands or feet (57%), cough (53%) skin changes (52%), worry (51%), and lack of appetite (49%). The median number of symptoms was not associated with WHO stage CD4 count group. Conclusion: This study demonstrates that the burden of HIV-related symptoms in individuals presenting for care in Uganda is significant and debilitating. © Mary Ann Liebert, Inc. Source

Namakoola I.,MRC UVRI Research Unit on AIDS | Wakeham K.,MRC UVRI Research Unit on AIDS | Parkes-Ratanshi R.,MRC UVRI Research Unit on AIDS | Parkes-Ratanshi R.,Imperial College London | And 6 more authors.
Tropical Medicine and International Health

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/μl 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/μl (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/μl 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. © 2010 Blackwell Publishing Ltd. Source

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