Sreenivasan Srirangaraj, Dasegowda Venkatesha
Department of Microbiology, Mysore Medical College and Research Institute, Mysore, India.
J Glob Infect Dis. 2011 Jul;3(3):265-8. doi: 10.4103/0974-777X.83533.
The high cost of CD4 count estimation in resource-limited settings is a major obstacle in initiating patients on highly active antiretroviral therapy (HAART). Thus, there is a need to evaluate other less expensive surrogate markers like total lymphocyte count (TLC) and absolute lymphocyte count (ALC).
To evaluate the correlation of TLC and ALC to CD4 count. To determine a range of TLC and ALC cut-offs for initiating HAART in HIV-infected patients in resource-limited settings.
In a prospective observational cohort study of 108 ART-naive HIV-positive patients, Spearman correlation between ALC and CD4 cell count, and TLC and CD4 cell count were assessed. Sensitivity, specificity, positive and negative predictive values of various ALC and TLC cut-offs were computed for CD4 count <200 cells/cu.mm.
Good correlation was noted between ALC and CD4 (r=0.5604) and TLC and CD4 (r=0.3497). ALC of 1400 cells/cu.mm had a sensitivity of 71.08% and specificity of 78.26% for predicting CD4 cell counts less than 200 cells/cu.mm. Similarly, TLC of 1200 cells/cu.mm had a sensitivity of 63.41% and specificity of 69.57%.
Either ALC or TLC may be helpful in deciding when to initiate antiretroviral therapy in resource-poor settings, though ALC is better than TLC as a surrogate for CD4 counts.
在资源有限的环境中，CD4细胞计数检测成本高昂，这是启动患者接受高效抗逆转录病毒治疗（HAART）的主要障碍。因此，有必要评估其他成本较低的替代指标，如总淋巴细胞计数（TLC）和绝对淋巴细胞计数（ALC）。
评估TLC和ALC与CD4细胞计数的相关性。确定在资源有限环境中启动HIV感染患者HAART的TLC和ALC临界值范围。
在一项对108例未接受过抗逆转录病毒治疗的HIV阳性患者的前瞻性观察队列研究中，评估了ALC与CD4细胞计数之间以及TLC与CD4细胞计数之间的Spearman相关性。计算了CD4细胞计数<200个/立方毫米时各种ALC和TLC临界值的敏感性、特异性、阳性和阴性预测值。
ALC与CD4之间（r = 0.5604）以及TLC与CD4之间（r = 0.3497）存在良好的相关性。对于预测CD4细胞计数小于200个/立方毫米，1400个/立方毫米的ALC敏感性为71.%;特异性为78.26%。同样，1200个/立方毫米的TLC敏感性为63.41%，特异性为69.57%。
在资源匮乏的环境中，ALC或TLC都可能有助于决定何时开始抗逆转录病毒治疗，不过作为CD4计数的替代指标，ALC优于TLC。
