Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective study
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 asses...
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| Format: | Article |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2014-01-01
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| Series: | Avicenna Journal of Medicine |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.4103/2231-0770.127413 |
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| author | Suman S Karanth N R Rau Anurag Gupta Asha Kamath Vikram Shanbhogue B C Pruthvi |
| author_facet | Suman S Karanth N R Rau Anurag Gupta Asha Kamath Vikram Shanbhogue B C Pruthvi |
| author_sort | Suman S Karanth |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T15:33:09Z |
| format | Article |
| id | doaj.art-123e3486905348aebf804126052349ea |
| institution | Directory Open Access Journal |
| issn | 2231-0770 2249-4464 |
| language | English |
| last_indexed | 2024-12-14T15:33:09Z |
| publishDate | 2014-01-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Avicenna Journal of Medicine |
| spelling | doaj.art-123e3486905348aebf804126052349ea2022-12-21T22:55:48ZengThieme Medical and Scientific Publishers Pvt. Ltd.Avicenna Journal of Medicine2231-07702249-44642014-01-0104011410.4103/2231-0770.127413Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective studySuman S Karanth0N R Rau1Anurag Gupta2Asha Kamath3Vikram Shanbhogue4B C Pruthvi5Department of Medicine, Kasturba Medical College, Manipal, IndiaDepartment of Medicine, Kasturba Medical College, Manipal, IndiaDepartment of Neurosurgery, Adarsha Superspeciality Hospital, Udupi, IndiaDepartment of Community Medicine, Kasturba Medical College, Manipal, IndiaDepartment of Medicine, Kasturba Medical College, Manipal, IndiaDepartment of Medicine, Vaalsalya Hospital, Shimoga, Karnataka, IndiaBackground: 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.http://www.thieme-connect.de/DOI/DOI?10.4103/2231-0770.127413cd4 counthuman immunodeficiency virussurrogate markertotal lymphocyte count |
| spellingShingle | Suman S Karanth N R Rau Anurag Gupta Asha Kamath Vikram Shanbhogue B C Pruthvi Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective study Avicenna Journal of Medicine cd4 count human immunodeficiency virus surrogate marker total lymphocyte count |
| title | Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective study |
| title_full | Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective study |
| title_fullStr | Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective study |
| title_full_unstemmed | Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective study |
| title_short | Utility of total lymphocyte count as a surrogate for absolute CD4 count in the adult Indian HIV population: A prospective study |
| title_sort | utility of total lymphocyte count as a surrogate for absolute cd4 count in the adult indian hiv population a prospective study |
| topic | cd4 count human immunodeficiency virus surrogate marker total lymphocyte count |
| url | http://www.thieme-connect.de/DOI/DOI?10.4103/2231-0770.127413 |
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