Predicting CD4 count using total lymphocyte count: a sustainable tool for clinical decisions during HAART use.

Understanding the total lymphocyte count (TLC)-CD4 count relationship could aide design predictive instruments for making clinical decisions during antiretroviral therapy, especially in underserved resource-poor settings. We performed multiple regression analyses to assess the prediction of CD4 count using TLC on 771 participants with 4,836 visits. In linear and logistic regression TLC, hemoglobin, gender, history of AIDS, and weight predicted CD4 count and CD4 < 200, respectively, before and after highly active antiretroviral therapy (HAART) use. On HAART, the adjusted odds ratios (OR) for TLC < 1500 (optimal TLC cutoff) were 5.1 (95%CI 4.0, 6.5; P < 0.001), and off HAART, 4.6 (95%CI 3.4, 6.2: P < 0.001) with high predictive power. TLC predicts CD4 count and CD4 < 200 cells/microL well during HAART. Including the additional factors improves performance. TLC is simple and inexpensive and can be used in many ways to develop clinical decision-making tools in underserved resource-poor settings during HAART therapy.

[1]  G. Friedland,et al.  Use of total lymphocyte count for monitoring response to antiretroviral therapy. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  A. Tang,et al.  Effect of dietary intake and protease inhibitors on serum vitamin B12 levels in a cohort of human immunodeficiency virus-positive patients. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  D. Spiegelman,et al.  Role of acquired immune deficiency syndrome-defining conditions in human immunodeficiency virus-associated wasting. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  Robert Oelrichs,et al.  Monitoring of human immunodeficiency virus infection in resource-constrained countries. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  Richard D Moore,et al.  Total lymphocyte count and hemoglobin combined in an algorithm to initiate the use of highly active antiretroviral therapy in resource‐limited settings , 2003, AIDS.

[6]  R. Wood,et al.  Usefulness of total lymphocyte count in monitoring highly active antiretroviral therapy in resource-limited settings , 2003, AIDS.

[7]  T. Flanigan,et al.  Total Lymphocyte Count (TLC) Is a Useful Tool for the Timing of Opportunistic Infection Prophylaxis in India and Other Resource‐Constrained Countries , 2002, Journal of acquired immune deficiency syndromes.

[8]  D. Spiegelman,et al.  Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy. , 2002, Journal of acquired immune deficiency syndromes.

[9]  R. Salamon,et al.  Clinical, Biologic, and Behavioral Predictors of Early Immunologic and Virologic Response in HIV‐Infected Patients Initiating Protease Inhibitors , 2001, Journal of acquired immune deficiency syndromes.

[10]  R. Salamon,et al.  Clinical, biologic, and behavioral predictors of early immunologic and virologic response in HIV-infected patients initiating protease inhibitors. , 2001 .

[11]  D. Spiegelman,et al.  Diarrhea and abnormalities of gastrointestinal function in a cohort of men and women with HIV infection , 2000, American Journal of Gastroenterology.

[12]  D. Spiegelman,et al.  Body Composition and Dietary Intake in Relation to Drug Abuse in a Cohort of HIV‐Positive Persons , 2000, Journal of acquired immune deficiency syndromes.

[13]  S. Gorbach,et al.  Weight loss and wasting remain common complications in individuals infected with human immunodeficiency virus in the era of highly active antiretroviral therapy. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  D. Spiegelman,et al.  Relation of Lean Body Mass to Health‐Related Quality of Life in Persons With HIV , 2000, Journal of acquired immune deficiency syndromes.

[15]  E. van der Ryst,et al.  Correlation among total lymphocyte count, absolute CD4+ count, and CD4+ percentage in a group of HIV-1-infected South African patients. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[16]  D. Spiegelman,et al.  The effect of protease inhibitors on weight and body composition in HIV‐infected patients , 1998, AIDS.

[17]  E. Beck,et al.  Correlation between total and CD4 lymphocyte counts in HIV infection: not making the good an enemy of the not so perfect , 1996, International journal of STD & AIDS.

[18]  T. Aufderheide,et al.  Test of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) for prehospital use. , 1996, Annals of emergency medicine.

[19]  James Curran,et al.  Scaling Up Antiretroviral Therapy in Resource-Limited Settings: Treatment Guidelines for a Public Health Approach , 2005 .

[20]  H. Selker.  Cardiac time-insensitive predictive instruments (TIPIs): real-time emergency clinical decision aids and tools for the retrospective assessment of care. , 2001, Maryland medicine : MM : a publication of MEDCHI, the Maryland State Medical Society.