Wang Yuming, Liang Shuying, Yu Erman, Guo Jinling, Li Zizhao, Wang Zhe, Du Yukai
Henan Provincial Medical Academy, Zhengzhou, 450003, China.
Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China.
J Huazhong Univ Sci Technolog Med Sci. 2011 Oct;31(5):712. doi: 10.1007/s11596-011-0588-8. Epub 2011 Oct 25.
CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy (HAART) and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings. This study examined the correlation between total lymphocyte count (TLC) and CD4 count of HIV-infected patients before and after HAART, and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART. A retrospective study was performed, and 665 HIV-infected patients with TLC and CD4 count from four counties (Shangcai, Queshan, Shenqiu and Weishi) were included in the study. Pearson correlation and receiver operating characteristic (ROC) were used. TLC and CD4 count after HAART was significantly increased as compared with pre-HAART (P<0.01). An overall positive correlation was noted between TLC and CD4 count (pre-HAART, r=0.73, P=0.0001; follow-up HAART, r=0.56, P=0.0001). The ROC curve between TLC and CD4 count showed that TLC ≤ 1200 cells/mm(3) could predict CD4 < 200 cells/mm(3) with a sensitivity of 71.12%, specificity of 66.35% at pre-HAART. After 12-month HAART, the optimum prediction for CD4 count < 200 cells/mm3 was a TLC ≤ 1300 cells/mm(3), with a sensitivity of 63.27%, and a specificity of 74.84%. Further finding indicated that TLC change was positively correlated to CD4 change (r=0.77, P=0.0001) at the time point of 12-month treatment, and the best prediction point of TLC change for CD4 increasing was 135 cells/mm(3). TLC and its change can be used as a surrogate marker for CD4 count and its change of HIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.
CD4细胞计数是确定高效抗逆转录病毒治疗（HAART）资格和监测HIV/AIDS疾病进展的标准方法，但在资源有限的环境中无法广泛应用。本研究检测了HAART前后HIV感染患者的总淋巴细胞计数（TLC）与CD4细胞计数之间的相关性，并评估了用于决定开始HAART和监测HAART的TLC阈值。进行了一项回顾性研究，纳入了来自四个县（上蔡、确山、沈丘和尉氏）的665例有TLC和CD4细胞计数的HIV感染患者。采用Pearson相关性分析和受试者工作特征（ROC）分析。与HAART前相比，HAART后TLC和CD4细胞计数显著增加（P<0.01）。TLC与CD4细胞计数之间总体呈正相关（HAART前，r=0.73，P=0.0001；HAART随访，r=0.56，P=0.0001）。TLC与CD4细胞计数之间的ROC曲线显示，在HAART前，TLC≤1200个细胞/mm³可预测CD4<200个细胞/mm³，敏感性为71.12%，特异性为66.35%。HAART治疗12个月后，预测CD4细胞计数<200个细胞/mm³的最佳TLC阈值为≤1300个细胞/mm³，敏感性为63.27%，特异性为74.84%。进一步研究表明，在治疗12个月时，TLC变化与CD4变化呈正相关（r=0.77，P=0.0001），TLC变化对CD4增加的最佳预测点为135个细胞/mm³。在资源有限的环境中，TLC及其变化可作为HIV感染者CD4细胞计数及其变化的替代指标，用于决定开始HAART和监测HAART。
