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Monitoring antiretroviral therapy in HIV/AIDS patients in resource-limited settings: CD4 counts or total lymphocyte counts? 2007

Dora Mbanya, and Felix Assah, and Nicaise Ndembi, and Lazare Kaptue
Department of Haematology, Faculty of Medicine & Biomedical Sciences, University of Yaoundé I, BP 8046, Yaoundé, Cameroon. dmbanya1@yahoo.co.uk

OBJECTIVE In order to improve the monitoring of disease progression and therapeutic effectiveness in the management of HIV/AIDS in a resource-limited setting, this study was carried out to establish a correlation between total lymphocyte counts (TLC) and CD4 lymphocyte counts in HIV-1 infected/AIDS adults in Yaoundé, Cameroon. METHODS Full blood counts, differential white, and CD4 counts were measured in 149 patients using standard methods. The correlation coefficient established correlation between values. Sensitivity, specificity, and positive predictive values were calculated as required. RESULTS The mean TLC, CD4 count, and CD4% as well as CD4/CD8 ratios were 1.932+/-0.895 x 10(9)/L, 268+/-183 cells/mm(3), 14.51+/-15.9%, and 0.34+/-0.25, respectively. Only a weak correlation was observed between TLC and CD4 counts (r=0.41, p=0.05). As a predictor of CD4 count, TLC cut-offs <2.0 and <1.0 x 10(9)/L were unable to predict these values reliably, but showed that at TLC cut-offs of <1.0 x 10(9)/L there was a high chance of CD4 counts being under 200 cells/mm(3). CONCLUSIONS These data suggest that TLC are of limited value in predicting CD4 counts and should not be substituted for CD4 counts whenever possible. However, TLC may be reliably used in designing algorithms and programs for initiating patient management and follow-up in this setting.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002163 Cameroon A republic in central Africa lying east of CHAD and the CENTRAL AFRICAN REPUBLIC and west of NIGERIA. The capital is Yaounde. Republic of Cameron,Cameroons,United Republic of Cameroon
D003430 Cross-Sectional Studies Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time. Disease Frequency Surveys,Prevalence Studies,Analysis, Cross-Sectional,Cross Sectional Analysis,Cross-Sectional Survey,Surveys, Disease Frequency,Analyses, Cross Sectional,Analyses, Cross-Sectional,Analysis, Cross Sectional,Cross Sectional Analyses,Cross Sectional Studies,Cross Sectional Survey,Cross-Sectional Analyses,Cross-Sectional Analysis,Cross-Sectional Study,Cross-Sectional Surveys,Disease Frequency Survey,Prevalence Study,Studies, Cross-Sectional,Studies, Prevalence,Study, Cross-Sectional,Study, Prevalence,Survey, Cross-Sectional,Survey, Disease Frequency,Surveys, Cross-Sectional
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000163 Acquired Immunodeficiency Syndrome An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive T-lymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. AIDS,Immunodeficiency Syndrome, Acquired,Immunologic Deficiency Syndrome, Acquired,Acquired Immune Deficiency Syndrome,Acquired Immuno-Deficiency Syndrome,Acquired Immuno Deficiency Syndrome,Acquired Immuno-Deficiency Syndromes,Acquired Immunodeficiency Syndromes,Immuno-Deficiency Syndrome, Acquired,Immuno-Deficiency Syndromes, Acquired,Immunodeficiency Syndromes, Acquired,Syndrome, Acquired Immuno-Deficiency,Syndrome, Acquired Immunodeficiency,Syndromes, Acquired Immuno-Deficiency,Syndromes, Acquired Immunodeficiency
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012680 Sensitivity and Specificity Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed) Specificity,Sensitivity,Specificity and Sensitivity
D015658 HIV Infections Includes the spectrum of human immunodeficiency virus infections that range from asymptomatic seropositivity, thru AIDS-related complex (ARC), to acquired immunodeficiency syndrome (AIDS). HTLV-III Infections,HTLV-III-LAV Infections,T-Lymphotropic Virus Type III Infections, Human,HIV Coinfection,Coinfection, HIV,Coinfections, HIV,HIV Coinfections,HIV Infection,HTLV III Infections,HTLV III LAV Infections,HTLV-III Infection,HTLV-III-LAV Infection,Infection, HIV,Infection, HTLV-III,Infection, HTLV-III-LAV,Infections, HIV,Infections, HTLV-III,Infections, HTLV-III-LAV,T Lymphotropic Virus Type III Infections, Human

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