Gray, Distal-Banded Nails Predict Low CD4 Count in HIV
Nails may help identify candidates for antiretroviral therapy in Africa
THURSDAY, July 13 (HealthDay News) -- The presence of gray or distal-banded nails can help clinicians identify HIV-infected patients in sub-Saharan Africa who are likely to benefit from antiretroviral therapy, according to a study in the June 26 issue of AIDS.
Using a set of 242 photographs, Matthew Scarborough, M.D., of the John Radcliffe Hospital in Oxford, U.K., and colleagues tested to see if three blinded independent observers could identify patients with a CD4 cell count of less than 200 cells/μL who had not yet presented with AIDS-defining illnesses, by the presence of gray or distal-banded nails.
The investigators found that the positive predictive value of gray nails for a CD4 cell count of less than 200 cells/μL was 81 percent and the positive predictive value of gray or distal-banded nails for a CD4 cell count of less than 350 cells/μL was 92 percent. The specificity of the nails compares with other World Health Organization stage III diagnoses such as oral candida, they report.
"Gray nails have been associated with HIV infection and we have shown significant correlation of this sign with a low CD4 cell count," the authors conclude. "For clinicians working in sub-Saharan Africa without access to CD4 cell count testing, gray or distal-banded nails represent an additional staging sign to help identify a subgroup of patients likely to benefit from antiretroviral therapy."