Mgomella G S, Venkatesh P A, Bosch R J, Mwakagile D, Urassa W, McIntosh K, Hertzmark E, Msamanga G, Fawzi W W
MUHAS-Harvard Informatics Training Project, Project. P.O.Box 65015, Dar es Salaam, Tanzania.
East Afr J Public Health. 2010 Jun;7(2):160-4.
Human Immunodeficiency Virus type 1 (HIV-1) infection leads to a progressive decline in CD4+ T-lymphocyte (CD4) cells. Initiation of prophylaxis against Opportunistic infections in adults (CD4% used for children) and antiretroviral therapy is usually based on CD4 cell counts, but CD4 cell counts measurement is not affordable in most African countries.
To examine whether total lymphocyte counts (TLC) may be used as proxies for low CD4 cell counts.
Cross-sectional at baseline when women were pregnant and at least six months postpartum.
1,078 HIV-1-infected pregnant women from Dar es Salaam, Tanzania were enrolled in a randomized clinical trial. A series of receiver operator characteristic (ROC) curves were created at baseline and at least 6 months postpartum and among women in WHO Stage 3 and above. The sensitivity and specificity of TLC and hemoglobin in predicting an absolute CD4 count < 200 cells/mm3 were determined for various clinically relevant cut points.
TLC was not a good predictor of low CD4 cell counts during pregnancy or at least six months postpartum as exhibited by low ROC Area Under the Curve (AUCs) of .57 and .62 respectively. No other variable had the ability to predict CD4 < 200 cells/mm3.
The use of TLC as a proxy for the estimation of low CD4 cell counts in a population of HIV-1-infected adults from sub-Saharan Africa was not substantiated. Inexpensive methods to quantify CD4 cell counts in Africa are needed.
1型人类免疫缺陷病毒（HIV-1）感染会导致CD4+T淋巴细胞（CD4）数量逐渐下降。成人预防机会性感染（儿童使用CD4%）和抗逆转录病毒治疗的起始通常基于CD4细胞计数，但在大多数非洲国家，CD4细胞计数检测费用高昂。
研究总淋巴细胞计数（TLC）是否可作为低CD4细胞计数的替代指标。
在女性怀孕时及产后至少6个月进行基线横断面研究。
来自坦桑尼亚达累斯萨拉姆的1078名感染HIV-1的孕妇参与了一项随机临床试验。在基线、产后至少6个月以及世界卫生组织3期及以上的女性中绘制了一系列受试者工作特征（ROC）曲线。针对不同的临床相关切点，确定了TLC和血红蛋白预测绝对CD4计数<200个细胞/mm³的敏感性和特异性。
TLC并非孕期或产后至少6个月低CD4细胞计数的良好预测指标，曲线下面积（AUC）分别为0.57和0.62，数值较低。没有其他变量能够预测CD4<200个细胞/mm³。
在撒哈拉以南非洲的HIV-1感染成年人群中，使用TLC作为低CD4细胞计数估计指标的依据并不充分。非洲需要廉价的CD4细胞计数定量方法。
