Further experience with the world health organization clinical case definition for AIDS in Uganda

The diagnostic value of the World Health Organizations (WHOs) clinical case definition for acquired immunodeficiency syndrome (AIDS) was reassessed in 99 patients aged 16 years and above who presented to the Internal Medicine ward of Ugandas Mulago Hospital in August-December 1987. The 39 cases met the WHO clinical case definition of AIDS with at least 2 major and 1 minor signs; the control group was comprised of 60 consecutive admissions to the emergency ward who did not fulfill the WHO case definition. Blood samples from each study participant were tested for antibodies to human immunodeficiency virus (HIV)-1 through use of the Organon-Teknika enzyme-linked immunosorbent assay (ELISA) and the DuPont Western blot tests. 85% of the cases and 30% of controls were seropositive for HIV-1. Thus the WHO clinical case definition had a sensitivity of 65% a specificity of 88% and a positive predictive value for HIV-1 seropositivity of 85%. Similar values have been recorded in other centers in Uganda and in Zaire. Various modifications of the case definition were explored; however none resulted in any significant overall improvements in its diagnostic value. It was concluded that the WHO clinical case definition for AIDS is adequate in central African populations and its continued use is recommended.