{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T16:39:03Z","timestamp":1774543143071,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2010,1,12]],"date-time":"2010-01-12T00:00:00Z","timestamp":1263254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2010,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Objectives\u2002<\/jats:bold> To evaluate the use of grey\/distal banded nails as an indicator of advanced immunosuppression, and thus eligibility for ART, in resource poor settings.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> We tested whether grey\/distal banded nails and\/or oral pigmentation could be used to identify patients with low CD4 cell counts at two cut\u2010offs: &lt;200 and &lt;350\u2003cells\/\u03bcl in ART naive adults.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> Four hundred and three nail and oral cavities were photographed and assessed. Grey\/distal banded nails and\/or oral pigmentation were significantly associated with a CD4 cell count &lt;200\u2003cells\/\u03bcl (<jats:italic>P<\/jats:italic>\u2003&lt;\u20030.001), with a sensitivity of 66%, a specificity of 50% and a negative predictive value of 77%. However, there was no association when a CD4 cell count cut\u2010off of &lt;350\u2003cells\/\u03bcl was used. Inter\u2010observer agreement (<jats:italic>k<\/jats:italic> 0.46) was fair\/moderate.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> While grey\/distal banded nails and\/or oral pigmentation are associated with low CD4 counts, the sensitivity and kappa score are too low for this method to be recommended as a tool to guide ART initiation; large number of individuals eligible for ART would be missed.<\/jats:p>","DOI":"10.1111\/j.1365-3156.2009.02448.x","type":"journal-article","created":{"date-parts":[[2010,1,13]],"date-time":"2010-01-13T01:20:18Z","timestamp":1263345618000},"page":"259-262","source":"Crossref","is-referenced-by-count":10,"title":["Use of nail and oral pigmentation to determine ART eligibility among HIV\u2010infected Ugandan adults"],"prefix":"10.1111","volume":"15","author":[{"given":"I.","family":"Namakoola","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Wakeham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Parkes\u2010Ratanshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Levin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Mugagga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Seymour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Kissa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Kamali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. G.","family":"Lalloo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,1,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2007.0353"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60612-7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.134.10.1216"},{"key":"e_1_2_7_5_1","first-page":"89","article-title":"Dermatological manifestations of human immunodeficiency virus infected\/acquired immunodeficiency syndrome patients in a referral hospital of Central Kerala","volume":"61","author":"Criton S","year":"1995","journal-title":"Indian Journal of Dermatology, Venereology and Leprology"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(97)70295-0"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-6405-5-4"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-4362.1999.00644.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32810c8dce"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.1998.02310.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000233575.26349.cc"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2009.009092"},{"key":"e_1_2_7_14_1","unstructured":"WHO(2006)Antiretroviral Therapy for HIV Infection in Adults and Adolescents in Resource\u2010Limited Settings: Towards Universal Access: Recommendations for a Public Health Approach.WHO Geneva."},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2005.12.030"}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1365-3156.2009.02448.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1365-3156.2009.02448.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T04:26:15Z","timestamp":1697257575000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-3156.2009.02448.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,1,12]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2010,2]]}},"alternative-id":["10.1111\/j.1365-3156.2009.02448.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1365-3156.2009.02448.x","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,1,12]]}}}