Screening HIV-infected adults in Malawi for anaemia: impact on eligibility for antiretroviral therapy

Clinical staging determines antiretroviral therapy (ART) eligibility when CD4 count is not available. Haemoglobin (Hb) <= 8 g/dL is an indication for the treatment. We measured Hb in HIV-positive Malawian adults undergoing clinical assessment for ART eligibility and calculated the percentage of patients with CD4 <= 350 cells/mu L deemed eligible for ART by clinical staging with and without Hb measurement, using the existing threshold and an alternative proposed after comparing Hb values to CD4 counts. Three hundred and thirty-eight patients had CD4 counts measured and 226 (67%) had CD4 <= 350 cells/mu L. Thirty-six (16%) patients with low CD4 count were eligible for ART by clinical assessment alone, 48 (21%) when Hb was also measured with a threshold of <= 8 g/dL and 74 (34%) with a threshold of <= 10 g/dL. Measuring Hb alongside clinical assessment could increase the number of patients with CD4 <= 350 cells/mu L starting ART by 33% using a threshold of Hb <= 8 g/dL or 114% with a threshold of <= 10g/dL.