Sagar Amitabh, Pathak Abhishek, Ambiya Vikas, Naithani Nardeep, Vasudevan Biju, Agrawal Sunil
Associate Professor, Dept of Internal Medicine, Armed Forces Medical College, Pune 40, India.
Graded Specialist (Medicine), 166 Military Hospital, C/o 56 APO, India.
Med J Armed Forces India. 2014 Jan;70(1):48-52. doi: 10.1016/j.mjafi.2013.04.002. Epub 2013 Aug 6.
Human immunodeficiency virus (HIV) management has witnessed paradigm changes over the past decade. In the early era, Absolute lymphocyte counts (ALC) were used as an inexpensive, indirect marker of immunity status. With time, CD4 lymphocyte counts and HIV RNA levels have become a standard of care for follow up of people living with HIV/AIDS (PLHA). Wide disparities between resource rich and poor countries, rekindles the need for an inexpensive surrogate marker for CD4 lymphocyte counts. Multiple studies in the past including one by Sen S et al, in 2011 did not validate ALC as a surrogate marker of CD4 lymphocyte counts and had recommended a similar study at another centre to validate the same.(1) Recently few publications have suggested that ALC may be used as a proxy marker to CD4 lymphocyte counts in resource poor areas.(2) With this backdrop we decided to evaluate the association if any, of ALC as a surrogate marker to CD4 lymphocyte counts.
ALC and CD4 lymphocyte counts measurements of 241 patients at our HIV/AIDS referral centre were assessed over a period of 13 months.
Pearson correlation coefficient, coefficient of determination and standard statistical methods revealed modest linear correlation between ALC and CD4 lymphocyte counts which was statistically significant but did not have clinical significance.
We recommend that time has come to call curtains down on ALC as a surrogate marker for CD4 lymphocyte count.
在过去十年中，人类免疫缺陷病毒（HIV）管理发生了范式转变。在早期，绝对淋巴细胞计数（ALC）被用作免疫状态的一种廉价间接标志物。随着时间的推移，CD4淋巴细胞计数和HIV RNA水平已成为HIV/AIDS患者（PLHA）随访的标准治疗指标。资源丰富和贫穷国家之间存在巨大差距，这再次凸显了对一种廉价的CD4淋巴细胞计数替代标志物的需求。过去的多项研究，包括Sen S等人在2011年进行的一项研究，并未验证ALC作为CD4淋巴细胞计数的替代标志物，并建议在另一个中心进行类似研究以验证这一点。（1）最近有几篇出版物表明，在资源匮乏地区，ALC可作为CD4淋巴细胞计数的替代标志物。（2）在此背景下，我们决定评估ALC作为CD4淋巴细胞计数替代标志物是否存在关联。
在13个月的时间里，对我们HIV/AIDS转诊中心的241名患者的ALC和CD4淋巴细胞计数进行了评估。
Pearson相关系数、决定系数和标准统计方法显示，ALC与CD4淋巴细胞计数之间存在适度的线性相关性，具有统计学意义，但不具有临床意义。
我们建议，是时候不再将ALC用作CD4淋巴细胞计数的替代标志物了。
