Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective study.

Autor:	Karanth SS; Department of Medicine, Kasturba Medical College, Manipal, India., Rau NR; Department of Medicine, Kasturba Medical College, Manipal, India., Gupta A; Department of Neurosurgery, Adarsha Superspeciality Hospital, Udupi, India., Kamath A; Department of Community Medicine, Kasturba Medical College, Manipal, India., Shanbhogue V; Department of Medicine, Kasturba Medical College, Manipal, India., Pruthvi BC; Department of Medicine, Vaalsalya Hospital, Shimoga, Karnataka, India.
Jazyk:	angličtina
Zdroj:	Avicenna journal of medicine [Avicenna J Med] 2014 Jan; Vol. 4 (1), pp. 1-4.
DOI:	10.4103/2231-0770.127413
Abstrakt:	Background: Standard methods of CD4 counts and plasma viral load estimation require specialized equipment, highly trained personnel and are extremely expensive. This remains a major challenge for the initiation of anti-retroviral therapy for patients in resource-limited settings. Objective: To assess the clinical utility of the total lymphocyte count (TLC) to serve as a surrogate marker for predicting a CD4 counts <350 cell/mm(3) in patients with HIV. Materials and Methods: A prospective study of 200 consecutive newly detected highly active anti-retroviral therapy (HAART) naïve HIV patients admitted over a one year period was conducted. Linear regression, Pearson correlation and receiver operating characteristic (ROC) curves were used to calculate the relationship between TLC and CD4 counts. Results: A significant correlation between TLC and CD4 count was observed (r = 0.682, P < 0.001). TLC cut off of 1200 cell/mm(3) as a predictor of CD4 count <350 cell/mm(3) had 73.1% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 51.4% negative predictive value (NPV). Raising the cutoff to 1500 cells/mm(3) improved the sensitivity to 82.1% with 88.2% specificity, 96.5% PPV, 44.4% NPV. The ROC curve demonstrated highest area under curve (AUC = 0.8) for TLC of 1500 cell/mm(3). Conclusion: The study showed that TLC cutoff value of 1500 cells/mm(3) was a cost effective surrogate marker for CD4 counts <350 cells/mm(3) in resource-limited settings.
Databáze:	MEDLINE
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