Abstract
BackgroundCD4 count is a standard measure of immunodeficiency in adults infected with HIV to initiate and monitor highly active antiretroviral therapy; however, it may not be feasible in resource poor countries. There is a need to have another marker of immunodeficiency that is less resource demanding.ObjectiveThe objective of this study was to assess the relationship between total lymphocyte count and CD4 count in one of the resource poor countries, Ethiopia.MethodsThis was a retrospective evaluation. A total of 2019 cases with total lymphocyte and CD4 counts from three hospitals (Yirgalem, Hossana and Arba-Minch) were included in the study. Pearson correlation, linear regression and Receiver Operating Characteristic (ROC) were used.ResultFor adults, the sensitivity, specificity, positive and negative predictive values of TLC < 1200 cells/mm3 to predict CD4 count < 200 cells/mm3 were 41%, 83.5%, 87.9% and 32.5%, respectively. For subjects aged less than 18 years, these values were 20.2%, 87%, 82% and 27.1%, respectively. A TLC ≤ 1780 cells/mm3 was found to have maximal sensitivity (61%) and specificity (62%) for predicting a CD4 cell count of < 200 cells/mm3. Meanwhile, a TLC ≤ 1885 cells/mm3 would identify only 59% of patients with CD4 count of < 350 cells/mm3(sensitivity, 59%; and specificity, 61%). The combined sensitivity and specificity for patients above 40 years of age was greater.ConclusionOur data revealed low sensitivity and specificity of TLC as a surrogate measure for CD4 count.
Highlights
CD4 count is a standard measure of immunodeficiency in adults infected with HIV to initiate and monitor highly active antiretroviral therapy; it may not be feasible in resource poor countries
The proportion of people who have become infected with HIV is believed to have peaked in the late 1990s and stabilized subsequently; the incidence is still increasing in several countries [2]
The determination of CD4 count has become a standard measure of immunodeficiency in adults infected with HIV in resource rich areas where the burden of the pandemic is low [3]
Summary
CD4 count is a standard measure of immunodeficiency in adults infected with HIV to initiate and monitor highly active antiretroviral therapy; it may not be feasible in resource poor countries. The determination of CD4 count has become a standard measure of immunodeficiency in adults infected with HIV in resource rich areas where the burden of the pandemic is low [3]. Cognizant of this problem, the current guidelines from World Health Organization (WHO) acknowledge that total lymphocyte count (TLC) may be used to make treatment decision in resource poor settings when CD4 count is not available and patients are mildly symptomatic [4]
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