Shah I, Parikh S
Department of Pediatrics, Pediatric HIV Clinic, B. J. Wadia Hospital for Children, Mumbai, Maharashtra, India.
J Postgrad Med. 2012 Jul-Sep;58(3):176-9. doi: 10.4103/0022-3859.101375.
CD4 counts are a standard laboratory measure of disease progression in HIV-infected children. However, CD4 counting is done by flow cytometry and may not always be possible in every centre treating HIV-infected children in resource-limited countries. Absolute Lymphocyte Count (ALC) can be derived easily by performing a routine white blood cell count. The World Health Organization (WHO) in 2006 had recommended ALC to identify HIV-infected children in need of ART in resource-limited settings, when CD4 cell count is not available.
This study aims to assess the reliability of using ALC as a marker for starting antiretroviral therapy (ART) in HIV-infected children in a tertiary hospital setting.
Retrospective analysis of 46 HIV-infected children who presented at a pediatric HIV clinic at a tertiary referral centre from 2002-2005.
Using WHO 2006 guidelines for cutoff values of ALC and 2008 guidelines for CD4% as a comparative standard, a retrospective analysis was done on ART-naοve HIV-infected children who underwent baseline CD4% and ALC, and sensitivity and specificity of ALC was calculated.
Fischer exact two-tailed analysis was used to correlate ALC and CD4 and need for starting ART.
Sensitivity of ALC was 27.6% (72.4% were false negatives), specificity was 70.6%, with positive predictive value of 61.5%. On comparison across all clinical stages of disease, only 13/46 children (28.2%) would have been started on ART according to ALC cutoffs versus 29/46 children (63.04%) using CD4 criteria (P value=0.0015). In children with WHO clinical Stage 1 or 2 of disease, only 1/11 (9.1%) children were identified by ALC as requiring ART as opposed to 6/11 (54.5%) children by CD4% (P=0.0635).
ALC is an unreliable marker to determine the need for starting ART in HIV-infected children.
CD4细胞计数是衡量HIV感染儿童疾病进展的一项标准实验室指标。然而，CD4细胞计数是通过流式细胞术进行的，在资源有限国家的每个治疗HIV感染儿童的中心并非总能进行该项检测。通过进行常规白细胞计数可轻松得出绝对淋巴细胞计数（ALC）。2006年世界卫生组织（WHO）建议，在资源有限的环境中，当无法获得CD4细胞计数时，可使用ALC来识别需要接受抗逆转录病毒治疗（ART）的HIV感染儿童。
本研究旨在评估在一家三级医院环境中，使用ALC作为启动HIV感染儿童抗逆转录病毒治疗（ART）标志物的可靠性。
对2002年至2005年在一家三级转诊中心的儿科HIV诊所就诊的46名HIV感染儿童进行回顾性分析。
以WHO 2006年ALC临界值指南和2008年CD4%指南作为比较标准，对未接受过ART的HIV感染儿童进行基线CD4%和ALC检测，并计算ALC的敏感性和特异性。
采用Fisher精确双侧分析来关联ALC与CD4以及启动ART的必要性。
ALC的敏感性为27.6%（72.4%为假阴性），特异性为70.6%，阳性预测值为61.5%。在对疾病的所有临床阶段进行比较时，根据ALC临界值，只有13/46名儿童（28.2%）会开始接受ART，而使用CD4标准则为29/46名儿童（63.04%）（P值 = 0.0015）。在WHO临床疾病1期或2期的儿童中，只有1/11（9.1%）的儿童被ALC确定需要接受ART，而通过CD4%确定的为6/11（54.5%）的儿童（P = 0.0635）。
ALC是确定HIV感染儿童是否需要启动ART的不可靠标志物。
