Evaluation of a clinical case-definition of acquired immunodeficiency syndrome in Africa

Abstract

A provisional clinical case-definition for acquired immunodeficiency syndrome (AIDS) developed by the World Health Organisation (WHO) for use in Africa was tested on 174 inpatients at Mama Yemo Hospital, Kinshasa, Zaire. In this hospital population with a 34% infection rate of human immunodeficiency virus (HIV), the clinical case-definition had a specificity of 90%, a sensitivity of 59%, and a predictive value of 74% for HIV seropositivity. These results support the use of the WHO clinical definition for AIDS in Africa. However, since HIV prevalence and disease expression vary, similar evaluations should be carried out in different regions.

PIP: A provisional clinical case definition for acquired immunodeficiency syndrome (AIDS) developed by the World Health Organization (WHO) for use in Africa was tested on 174 inpatients at Mama Yemo Hospital, Kinshasa, Zaire. According to this definition, the diagnosis of AIDS requires the existence of at least 2 of the major signs (weight loss greater than 10% of body weight, chronic diarrhea for more than 1 month) in association with at least 1 minor sign (persistent cough for more than 1 month, general pruritic dermatitis, recurrent herpes zpster, oopharyngeal candidiasis, chronic progressive and disseminated herpes simplex infection, general lymphadenopathy) in the absence of other known causes of immunosuppression. In this hospital population with a 34% infection rate of human immunodeficiency virus (HIV), the clinical case definition had a specificity of 90%, a sensitivity of 59%, and a predictive value of 74% for HIV seropositivity. Among the major symptoms and signs of the case definition, chronic diarrhea was the most specific. Of the 12 HIV-seronegative patients meeting the criteria of the AIDS case difinition, 6 had tuberculosis and 3 had suspected tuberculosis. Tuberculosis is the most common differential diagnosis problem in the design of a clinical case definition of African AIDS. When the criteria of persistent cough for longer than 1 month or general lymphadenopathy were not used for patients with proven tuberculosis, the WHO clinical definition was 93% specific, 55% sensitive, and had a positive predictive value for HIV seroprevalence and disease expression require that similar evaluations be carried out in other regions.