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CC BY-NC-ND 4.0 · Avicenna J Med 2014; 04(01): 1-4
DOI: 10.4103/2231-0770.127413
ORIGINAL ARTICLE

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

Suman S Karanth
Department of Medicine, Kasturba Medical College, Manipal, India
,
N R Rau
Department of Medicine, Kasturba Medical College, Manipal, India
,
Anurag Gupta
Department of Neurosurgery, Adarsha Superspeciality Hospital, Udupi, India
,
Asha Kamath
Department of Community Medicine, Kasturba Medical College, Manipal, India
,
Vikram Shanbhogue
Department of Medicine, Kasturba Medical College, Manipal, India
,
B C Pruthvi
Department of Medicine, Vaalsalya Hospital, Shimoga, Karnataka, India
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Abstract

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.

Keywords

CD4 count - human immunodeficiency virus - surrogate marker - total lymphocyte count


Publication History

Article published online:
09 August 2021

© 2014. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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