The use of total lymphocyte count (TLC) as an independent criterion for initiating HAART in resource-poor countries

Lee, Shui Shan; Wong, Ka-Hing

doi:10.1016/j.jinf.2003.11.011

Cited by 7 publications

(5 citation statements)

References 13 publications

(8 reference statements)

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“…[10] Various studies indicate different TLC cutoff to predict a CD4 <200 cells/mm 3 . In our study, in contrast to studies done by Spacek et al, Lee et al, and Badri et al, [10,11,14] failed to demonstrate a strong sensitivity between the WHO recommended TLC <1200 cells/mm 3 and CD4 count <200 cells/mm 3 . As CD4 count <350 cells/mm 3 is used as a cut off for anti-retroviral therapy, we further evaluated for a correlation between TLC and CD4 count <350 cell/mm 3 .…”

Section: Discussioncontrasting

confidence: 99%

“…[9] Studies by Spacek et al, and Lee et al, showed that the WHO recommended TLC <1200 cells/mm 3 with hemoglobin <12gm/dL was in fact an effective predictor for CD4 <200 cells/mm 3 . [1,10,11,12] In our study, median levels for CD4 count and TLC were lower than similar studies conducted by Akanmu et al, and Akinola et al, [8,13] [Table 1]. The correlation coefficient between CD4 count and TLC (r = 0.682, P < 0.001) showed a significant positive correlation while correlation with age (r = −0.157, P < 0.154) and total leucocyte count (r = 0.166, P < 0.146) was poor.…”

Section: Discussionmentioning

confidence: 99%

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2014

Avicenna J Med

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This produces a colossal financial burden especially in a country like India. As a consequence, there are irregular follow-ups, delay in therapy, increased disease burden and a resultant alarming multi-drug resistance. To overcome these problems, in April 2002 WHO recommended the usage of total lymphocyte count (TLC) less than 1000 to 1200 cells/mm 3 as indication to start HAART in resource-limited settings. [6] There are however conflicting reports as to whether TLC is a reliable substitution for CD4 count. In 2013, WHO revised its guidelines and recommended therapy to patients with severe or advanced HIV clinical disease (WHO clinical stage 3 INTRODUCTIONThe burden of HIV remains high for patients and their families especially in resource-limited settings. It is estimated that 40 million people with human immunodeficiency virus (HIV) reside in resource-limited settings. Among them it is reported that 6 million require highly active anti retroviral therapy (HAART). [1] In India alone, there are 2-3 million people infected with HIV. [2] Ideally the WHO recommends regular combined immunological and virological monitoring for all HIV-infected patients. [3] Analysis for viral loads and CD4 counts require not only sophisticated equipment, but in addition, highly skilled

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Untitled

2014

Avicenna J Med

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“…[9] Studies by Spacek et al ., and Lee et al ., showed that the WHO recommended TLC <1200 cells/mm 3 with hemoglobin <12gm/dL was in fact an effective predictor for CD4 <200 cells/mm 3 . [1101112]…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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/mm3 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/mm3 as a predictor of CD4 count <350 cell/mm3 had 73.1% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 51.4% negative predictive value (NPV). Raising the cutoff to 1500 cells/mm3 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/mm3.Conclusion:The study showed that TLC cutoff value of 1500 cells/mm3 was a cost effective surrogate marker for CD4 counts <350 cells/mm3 in resource-limited settings.

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“…In this resource poor setting, TLC was used as a surrogate marker for CD4 cell count since by then, the capacity to determine the latter was not readily available to the general public due to prohibitive costs. TLC of 1200 cells/mm 3 was the threshold value used equivalent to a CD4 count of 200 cells/mm 3 [ 12 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

Antenatal HIV-1 RNA load and timing of mother to child transmission; a nested case-control study in a resource poor setting

Duri

Gumbo

Kristiansen

et al. 2010

Virol J

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ObjectiveTo determine HIV-1 RNA load during the third trimester of pregnancy and evaluate its effect on in utero and intra-partum/postpartum transmissions in a breastfeeding population.DesignA nested case-control study within a PMTCT cohort of antiretroviral therapy naive pregnant women and their infants.MethodsA case was a mother who transmitted HIV-1 to her infant (transmitter) who was matched to one HIV-1 positive but non-transmitting mother (control).ResultsFrom a cohort of 691 pregnant women, 177 (25.6%) were HIV-1 positive at enrolment and from these 29 (23%) transmitted HIV-1 to their infants, 10 and 19 during in utero and intra-partum/postpartum respectively. Twenty-four mothers sero-converted after delivery and three transmitted HIV-1 to their infants. Each unit increase in log10 viral load was associated with a 178 cells/mm3 and 0.2 g/dL decrease in TLC and hemoglobin levels, p = 0.048 and 0.021 respectively, and a 29% increase in the risk of transmission, p = 0.023. Intra-partum/postpartum transmitters had significantly higher mean viral load relative to their matched controls, p = 0.034.ConclusionAntenatal serum HIV-1 RNA load, TLC and hemoglobin levels were significantly associated with vertical transmission but this association was independent of transmission time. This finding supports the rationale for preventive strategies designed to reduce vertical transmission by lowering maternal viral load.

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The use of total lymphocyte count (TLC) as an independent criterion for initiating HAART in resource-poor countries

Cited by 7 publications

References 13 publications

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Untitled

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

Antenatal HIV-1 RNA load and timing of mother to child transmission; a nested case-control study in a resource poor setting

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