Article révisé par les pairs
Résumé : Objective: To evaluate the clinical axis of the World Health Organization (WHO) clinical staging system and the modified WHO staging system proposed by Montaner et al. using the lymphocyte strata >1500, 1500-1000 and <1000 cells × 106/l. Design: Cross-sectional study. Patients: Four hundred and fifteen consecutive patients with HIV infection attending three HIV reference centres in Belgium. Methods: Absolute CD4 lymphocyte counts were compared between stages within the two staging systems. Results: Median CD4 lymphocyte counts decreased with increasing stage of disease in both staging systems. Differences in median CD4 lymphocyte counts between stages of each staging system were statistically significant (Kruskal-Wallis one-way analysis of variance, P<0.001). The WHO clinical stage 1 and the modified WHO stage I had positive predictive values of 56 and 58%, respectively, for identifying patients with CD4 lymphocyte levels >500 cells ×106/l. The WHO clinical stage 4 and the modified WHO stage IV had positive predictive values of 79 and 80%, respectively, for identifying patients with CD4 lymphocyte levels <200 cells ×106/l. Conclusions: The WHO clinical staging system or a modified version of this system using lymphocytes stratification may be a good alternative in developing countries to the CD4 lymphocyte count-based HIV staging system used in the developed world. Cohort studies in developing countries are needed to assess their prognostic value.

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