Total Lymphocyte Count (TLC) Is a Useful Tool for the Timing of Opportunistic Infection Prophylaxis in India and Other Resource-Constrained Countries

Abstract

TLC could serve as a low-cost tool for determining both a patient's risk of OI and when to initiate prophylaxis in resource-constrained settings. PPV, NPV, sensitivity, and specificity maximally aggregated at TLC <1400 cells/mm3 for CD4 <200 cell/mm3 and TLC <1700 cells/mm3 for CD4 <350 cells/mm3. Selection of appropriate TLC cutoffs for prophylaxis administration should be made on a regional basis depending on OI incidence, antimicrobial resistance patterns, and availability of the antimicrobials.

Total lymphocyte count as a tool for timing opportunistic infection prophylaxis in resource-limited settings: a study from India

“…3497), indicating a moderately positive association between TLC and CD4 counts. However, Spearman correlations between TLC and CD4 count reported in North America (r = 0.77) [13], England (r = 0.76) [14] and India (r = 0.744) [8] were higher when compared with the results of this study. This difference could be due to the small size of the current study sample.…”

“…In an Indian study, Kumaraswamy et al found that a TLC of less than 1600 cells/mm 3 had a positive predictive value and sensitivity of 77% and 86%, respectively, for a CD4 count of less than 200 cells/mm 3 [8]. But, in our study, we found that a TLC of less than 2000cells/mm 3 had a positive predictive value and sensitivity of 100% and 95.24 % respectively, for a CD4 count of less than 200cells/mm 3 .…”

“…By maximizing sensitivity, patients most at risk for OI by the CD4 count threshold criteria of < 200 cells/mm 3 are most likely to receive prophylaxis [8]. As a guideline for initiating prophylaxis in this case, we would recommend the WHO prescribed TLC < 1200 cells/mm 3 for CD4 count < 200 cells/mm 3 .…”

“…There are very few studies examining the correlation of CD4 count to TLC in a cohort of HIVpositive patients from India [8].There is also little reported data regarding the correlation of TLC to CD4 counts in patients co-infected with HIV and tuberculosis (TB) [8,9].The need to assess TLC as a surrogate for CD4 count in patients with HIV and TB is underscored by the high prevalence of co-infection in resource-limited settings. Thus this study was conducted to evaluate the correlation of TLC to CD4 counts in HIV-positive patients attending the AntiRetroviral Therapy (ART) centre in Mysore, Karnataka, which is one of the high-prevalence states in India [10] and discuss the role TLC could play in the management of OI prophylaxis in resourcelimited settings.…”

Evaluation of treatment outcomes for patients on first‐line regimens in US President's Emergency Plan for AIDS Relief (PEPFAR) clinics in Uganda: predictors of virological and immunological response from RV288 analyses

“…The association between increases in total lymphocyte count from baseline and CD4+ cell recovery is not surprising, as CD4 cells are included in the total lymphocyte count, but increased total lymphocyte count after ART is associated with increased lymphocyte proliferation in response to an antigen [48]. Some have advocated the use of the total lymphocyte count as an inexpensive indicator for tracking HIV disease progression in resource-poor settings [49]; however, more recent studies demonstrate low sensitivity and specificity of total lymphocyte count as a surrogate measure of CD4 cell count [50].Patient satisfaction with care is a factor associated with improved medication adherence [51][52][53][54] and healthrelated quality of life [52], and consequently it was a predictor of CD4 cell recovery in our patients. Clinic travel costs, which were found to have a borderline significant effect on virological suppression, represent a barrier to accessing care and medication refills.…”