Total lymphocyte count as a surrogate marker for CD4 count in resource-limited settings
Identifieur interne : 000689 ( Main/Merge ); précédent : 000688; suivant : 000690Total lymphocyte count as a surrogate marker for CD4 count in resource-limited settings
Auteurs : Christian Obirikorang [Ghana] ; Lawrence Quaye [Ghana] ; Isaac Acheampong [Ghana]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2012.
Descripteurs français
- KwdFr :
- Adulte, Agents antiVIH (usage thérapeutique), Facteurs socioéconomiques, Femelle, Ghana, Humains, Indice de gravité médicale, Mâle, Numération des lymphocytes (utilisation), Numération des lymphocytes (économie), Numération des lymphocytes CD4 (utilisation), Numération des lymphocytes CD4 (économie), Sensibilité et spécificité, Séropositivité VIH (immunologie), Séropositivité VIH (traitement médicamenteux), Séropositivité VIH (économie), VIH-1 (Virus de l'Immunodéficience Humaine de type 1).
- MESH :
- immunologie : Séropositivité VIH.
- traitement médicamenteux : Séropositivité VIH.
- usage thérapeutique : Agents antiVIH.
- utilisation : Numération des lymphocytes, Numération des lymphocytes CD4.
- économie : Numération des lymphocytes, Numération des lymphocytes CD4, Séropositivité VIH.
- Adulte, Facteurs socioéconomiques, Femelle, Ghana, Humains, Indice de gravité médicale, Mâle, Sensibilité et spécificité, VIH-1 (Virus de l'Immunodéficience Humaine de type 1).
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- Adult, Anti-HIV Agents (therapeutic use), CD4 Lymphocyte Count (economics), CD4 Lymphocyte Count (utilization), Female, Ghana, HIV Seropositivity (drug therapy), HIV Seropositivity (economics), HIV Seropositivity (immunology), HIV-1, Humans, Lymphocyte Count (economics), Lymphocyte Count (utilization), Male, Sensitivity and Specificity, Severity of Illness Index, Socioeconomic Factors.
- MESH :
- chemical , therapeutic use : Anti-HIV Agents.
- geographic : Ghana.
- drug therapy : HIV Seropositivity.
- economics : CD4 Lymphocyte Count, HIV Seropositivity, Lymphocyte Count.
- immunology : HIV Seropositivity.
- utilization : CD4 Lymphocyte Count, Lymphocyte Count.
- Adult, Female, HIV-1, Humans, Male, Sensitivity and Specificity, Severity of Illness Index, Socioeconomic Factors.
Abstract
CD4 testing is the recognized gold standard used to stage HIV/AIDS, guide treatment decisions for HIV-infected persons and evaluate effectiveness of therapy. The need for a less expensive surrogate marker that can be used in resource-limited setting is however necessary. The study sought to assess the suitability of Total lymphocyte count (TLC) as a surrogate marker for CD4 count in resource-limited localities in Ghana.
This observational study was conducted at the Central Regional Hospital, which has one of the established antiretroviral therapy centres in Ghana. A total of one hundred and eighty-four (184) confirmed HIV I seropositive subjects were included in the study. Blood samples were taken from all the subjects for estimation of CD4 and total lymphocyte counts. The study subjects were further categorised into three (3) groups according to the Centers for Disease Control and Prevention (CDC) classification criteria as follows: CD4 counts (1) ≥ 500 cells/mm3 (2) 200–499 cells/mm3 and (3) <200 cells/mm3. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of various TLC cut-offs were computed for three groups. Correlation and Receiver Operator Characteristic analysis was performed for the various CD4 counts and their corresponding Total Lymphocyte count obtained.
The sensitivity, specificity, positive and negative predictive values of TLC 1200 cells/ mm3 to predict CD4 count were <200 cells/mm3 72.2%, 100%, 100% and 95.7% respectively. A TLC of 1500 cells/ mm3 was found to have maximal sensitivity (96.67%), specificity (100%), PPV (100%) and NPV (75.0%) for predicting a CD4 cell count of 200–499 cell/mm3. A TLC of 1900 cells/mm3 was also found to have a maximal sensitivity (98.45%), specificity (100%), PPV (100%) and NPV (100%) for predicting CD4 count ≥500 cells/mm3. A positive correlation was noted between 184 paired CD4 and TLC counts (r = 0.5728).
Total Lymphocyte count can therefore adequately serve as a surrogate marker for CD4 count in HIV patients who are naïve for antiretroviral therapy in resource-limited areas.
Url:
DOI: 10.1186/1471-2334-12-128
PubMed: 22676809
PubMed Central: 3407488
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PMC:3407488Le document en format XML
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Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Quaye, Lawrence" sort="Quaye, Lawrence" uniqKey="Quaye L" first="Lawrence" last="Quaye">Lawrence Quaye</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Medical Laboratory Sciences, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medical Laboratory Sciences, School of Medicine and Health Sciences, University for Development Studies, Tamale</wicri:regionArea><wicri:noRegion>Tamale</wicri:noRegion></affiliation></author><author><name sortKey="Acheampong, Isaac" sort="Acheampong, Isaac" uniqKey="Acheampong I" first="Isaac" last="Acheampong">Isaac Acheampong</name><affiliation wicri:level="1"><nlm:aff id="I3">Laboratory Department, University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Laboratory Department, University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Anti-HIV Agents (therapeutic use)</term><term>CD4 Lymphocyte Count (economics)</term><term>CD4 Lymphocyte Count (utilization)</term><term>Female</term><term>Ghana</term><term>HIV Seropositivity (drug therapy)</term><term>HIV Seropositivity (economics)</term><term>HIV Seropositivity (immunology)</term><term>HIV-1</term><term>Humans</term><term>Lymphocyte Count (economics)</term><term>Lymphocyte Count (utilization)</term><term>Male</term><term>Sensitivity and Specificity</term><term>Severity of Illness Index</term><term>Socioeconomic Factors</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Agents antiVIH (usage thérapeutique)</term><term>Facteurs socioéconomiques</term><term>Femelle</term><term>Ghana</term><term>Humains</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Numération des lymphocytes (utilisation)</term><term>Numération des lymphocytes (économie)</term><term>Numération des lymphocytes CD4 (utilisation)</term><term>Numération des lymphocytes CD4 (économie)</term><term>Sensibilité et spécificité</term><term>Séropositivité VIH (immunologie)</term><term>Séropositivité VIH (traitement médicamenteux)</term><term>Séropositivité VIH (économie)</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-HIV Agents</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Ghana</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Seropositivity</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>CD4 Lymphocyte Count</term><term>HIV Seropositivity</term><term>Lymphocyte Count</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Séropositivité VIH</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>HIV Seropositivity</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Séropositivité VIH</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Agents antiVIH</term></keywords><keywords scheme="MESH" qualifier="utilisation" xml:lang="fr"><term>Numération des lymphocytes</term><term>Numération des lymphocytes CD4</term></keywords><keywords scheme="MESH" qualifier="utilization" xml:lang="en"><term>CD4 Lymphocyte Count</term><term>Lymphocyte Count</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Numération des lymphocytes</term><term>Numération des lymphocytes CD4</term><term>Séropositivité VIH</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Female</term><term>HIV-1</term><term>Humans</term><term>Male</term><term>Sensitivity and Specificity</term><term>Severity of Illness Index</term><term>Socioeconomic Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Facteurs socioéconomiques</term><term>Femelle</term><term>Ghana</term><term>Humains</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Sensibilité et spécificité</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>CD4 testing is the recognized gold standard used to stage HIV/AIDS, guide treatment decisions for HIV-infected persons and evaluate effectiveness of therapy. The need for a less expensive surrogate marker that can be used in resource-limited setting is however necessary. The study sought to assess the suitability of Total lymphocyte count (TLC) as a surrogate marker for CD4 count in resource-limited localities in Ghana.</p></sec><sec><title>Methods</title><p>This observational study was conducted at the Central Regional Hospital, which has one of the established antiretroviral therapy centres in Ghana. A total of one hundred and eighty-four (184) confirmed HIV I seropositive subjects were included in the study. Blood samples were taken from all the subjects for estimation of CD4 and total lymphocyte counts. The study subjects were further categorised into three (3) groups according to the Centers for Disease Control and Prevention (CDC) classification criteria as follows: CD4 counts (1) ≥ 500 cells/mm<sup>3</sup> (2) 200–499 cells/mm<sup>3</sup> and (3) <200 cells/mm<sup>3</sup>. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of various TLC cut-offs were computed for three groups. Correlation and Receiver Operator Characteristic analysis was performed for the various CD4 counts and their corresponding Total Lymphocyte count obtained.</p></sec><sec><title>Results</title><p>The sensitivity, specificity, positive and negative predictive values of TLC 1200 cells/ mm<sup>3</sup> to predict CD4 count were <200 cells/mm<sup>3</sup> 72.2%, 100%, 100% and 95.7% respectively. A TLC of 1500 cells/ mm<sup>3</sup> was found to have maximal sensitivity (96.67%), specificity (100%), PPV (100%) and NPV (75.0%) for predicting a CD4 cell count of 200–499 cell/mm<sup>3</sup>. A TLC of 1900 cells/mm<sup>3</sup> was also found to have a maximal sensitivity (98.45%), specificity (100%), PPV (100%) and NPV (100%) for predicting CD4 count ≥500 cells/mm<sup>3</sup>. A positive correlation was noted between 184 paired CD4 and TLC counts (r = 0.5728).</p></sec><sec><title>Conclusion</title><p>Total Lymphocyte count can therefore adequately serve as a surrogate marker for CD4 count in HIV patients who are naïve for antiretroviral therapy in resource-limited areas.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Crowe, S" uniqKey="Crowe S">S Crowe</name></author><author><name sortKey="Turnbull, S" uniqKey="Turnbull S">S Turnbull</name></author><author><name sortKey="Oelrichs, R" uniqKey="Oelrichs R">R Oelrichs</name></author><author><name sortKey="Dunne, A" uniqKey="Dunne A">A Dunne</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kumarasamy, N" uniqKey="Kumarasamy N">N Kumarasamy</name></author><author><name sortKey="Mahajan, Ap" uniqKey="Mahajan A">AP Mahajan</name></author><author><name sortKey="Flanigan, Tp" uniqKey="Flanigan T">TP Flanigan</name></author><author><name sortKey="Hemalatha, R" uniqKey="Hemalatha R">R Hemalatha</name></author><author><name sortKey="Mayer, Kh" uniqKey="Mayer K">KH Mayer</name></author><author><name sortKey="Carpenter, Cc" uniqKey="Carpenter C">CC Carpenter</name></author><author><name sortKey="Thyagarajan, Sp" uniqKey="Thyagarajan S">SP Thyagarajan</name></author><author><name sortKey="Solomon, S" uniqKey="Solomon S">S Solomon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Spacek, La" uniqKey="Spacek L">LA Spacek</name></author><author><name sortKey="Griswold, M" uniqKey="Griswold M">M Griswold</name></author><author><name sortKey="Quinn, Tc" uniqKey="Quinn T">TC Quinn</name></author><author><name sortKey="Moore, Rd" uniqKey="Moore R">RD Moore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Der Ryst, E" uniqKey="Van Der Ryst E">E van der Ryst</name></author><author><name sortKey="Kotze, M" uniqKey="Kotze M">M Kotze</name></author><author><name sortKey="Joubert, G" uniqKey="Joubert G">G Joubert</name></author><author><name sortKey="Steyn, M" uniqKey="Steyn M">M Steyn</name></author><author><name sortKey="Pieters, H" uniqKey="Pieters H">H Pieters</name></author><author><name sortKey="Van Der Westhuizen, M" uniqKey="Van Der Westhuizen M">M van der Westhuizen</name></author><author><name sortKey="Van Staden, M" uniqKey="Van Staden M">M van Staden</name></author><author><name sortKey="Venter, C" uniqKey="Venter C">C Venter</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="George, Sj" uniqKey="George S">SJ George</name></author><author><name sortKey="Lau, B" uniqKey="Lau B">B Lau</name></author><author><name sortKey="Phair, Jp" uniqKey="Phair J">JP Phair</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Akanmu, As" uniqKey="Akanmu A">AS Akanmu</name></author><author><name sortKey="Akonsete, I" uniqKey="Akonsete I">I Akonsete</name></author><author><name sortKey="Eshoforiee, Ao" uniqKey="Eshoforiee A">AO Eshoforiee</name></author><author><name sortKey="Davies, Ao" uniqKey="Davies A">AO Davies</name></author><author><name sortKey="Okanny, Cc" uniqKey="Okanny C">CC Okanny</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Daka, D" uniqKey="Daka D">D Daka</name></author><author><name sortKey="Loha, E" uniqKey="Loha E">E Loha</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gougeon, Ml" uniqKey="Gougeon M">ML Gougeon</name></author><author><name sortKey="Montagnier, L" uniqKey="Montagnier L">L Montagnier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gil, L" uniqKey="Gil L">L Gil</name></author><author><name sortKey="Martinez, G" uniqKey="Martinez G">G Martinez</name></author><author><name sortKey="Gonzalez, I" uniqKey="Gonzalez I">I Gonzalez</name></author><author><name sortKey="Tarinas, A" uniqKey="Tarinas A">A Tarinas</name></author><author><name sortKey="Alvarez, A" uniqKey="Alvarez A">A Alvarez</name></author><author><name sortKey="Giuliani, A" uniqKey="Giuliani A">A Giuliani</name></author><author><name sortKey="Molina, R" uniqKey="Molina R">R Molina</name></author><author><name sortKey="Tapanes, R" uniqKey="Tapanes R">R Tapanes</name></author><author><name sortKey="Perez, J" uniqKey="Perez J">J Perez</name></author><author><name sortKey="Leon, Os" uniqKey="Leon O">OS Leon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Badri, M" uniqKey="Badri M">M Badri</name></author><author><name sortKey="Wood, R" uniqKey="Wood R">R Wood</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Post, Fa" uniqKey="Post F">FA Post</name></author><author><name sortKey="Wood, R" uniqKey="Wood R">R Wood</name></author><author><name 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sortKey="Torres, Aj" uniqKey="Torres A">AJ Torres</name></author><author><name sortKey="Ramos, Am" uniqKey="Ramos A">AM Ramos</name></author><author><name sortKey="Lima, M" uniqKey="Lima M">M Lima</name></author><author><name sortKey="Netto, Em" uniqKey="Netto E">EM Netto</name></author><author><name sortKey="Brites, C" uniqKey="Brites C">C Brites</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alavi, Sm" uniqKey="Alavi S">SM Alavi</name></author><author><name sortKey="Ahmadi, F" uniqKey="Ahmadi F">F Ahmadi</name></author><author><name sortKey="Farhadi, M" uniqKey="Farhadi M">M Farhadi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jacobson, Ma" uniqKey="Jacobson M">MA Jacobson</name></author><author><name sortKey="Liu, L" uniqKey="Liu L">L Liu</name></author><author><name sortKey="Khayam Bashi, H" uniqKey="Khayam Bashi H">H Khayam-Bashi</name></author><author><name sortKey="Deeks, Sg" uniqKey="Deeks S">SG Deeks</name></author><author><name sortKey="Hecht, Fm" uniqKey="Hecht F">FM Hecht</name></author><author><name sortKey="Kahn, J" uniqKey="Kahn J">J Kahn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pascale, Jm" uniqKey="Pascale J">JM Pascale</name></author><author><name sortKey="Isaacs, Md" uniqKey="Isaacs M">MD Isaacs</name></author><author><name sortKey="Contreras, P" uniqKey="Contreras P">P Contreras</name></author><author><name sortKey="Gomez, B" uniqKey="Gomez B">B Gomez</name></author><author><name sortKey="Lozano, L" uniqKey="Lozano L">L Lozano</name></author><author><name sortKey="Austin, E" uniqKey="Austin E">E Austin</name></author><author><name sortKey="De Martin, Mc" uniqKey="De Martin M">MC De Martin</name></author><author><name sortKey="Gregory, Rl" uniqKey="Gregory R">RL Gregory</name></author><author><name sortKey="Mclaughlin, Gl" uniqKey="Mclaughlin G">GL McLaughlin</name></author><author><name sortKey="Amador, A" uniqKey="Amador 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