Determination of eligibility to antiretroviral therapy in resource limited settings using total lymphocyte counts, hemoglobin and body mass index among HIV positive patients

Abstract

Abstract

Background: Acquired Immunodeficiency Syndrome is a serious public health problem in Ethiopia. CD4+ T cell count testing is the standard method for determining eligibility for antiretroviral therapy. However, automation for CD4+ T cell count is not widely available in sub-Saharan Africa including Ethiopia.

Objective: This study was to determine eligibility for antiretroviral therapy in resource-limited settings using total lymphocyte counts, hemoglobin and body mass index among HIV positive patients.

Materials and methods: CD4+ T cell count was determined using Becton Dickinson FACS count analyzer. Total lymphocyte count and hemoglobin concentration were measured by a Cell Dyne 1800 hematology analyzer and body mass index was determined. Correlation of total lymphocyte count, hemoglobin and body mass index with CD4+ T cell count was determined by Pearson’s correlation coefficient and p-value.

Results: The correlation between CD4+ T cell count and Total Lymphocyte Count (TLC) was not strong, but the association between CD4+ T cell count and TLC was highly significant and correlation between CD4+ T cell counts with hemoglobin were very weak. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of TLC using threshold value of 1000 cells/mm3 for CD4+ T cell counts <350 cells/mm3 were 3% , 94%, 17% and 71%, respectively. Total lymphocyte count threshold of 1750 cells/mm3 were the better predictor of CD4+ T cell counts of <350 cells/mm3 when compared to < 200 cells/mm3.

Conclusion: TLC showed weak correlation with CD4+ T cell counts but the association between CD4+ T cell count with TLC was significant (p<0.0001). The TLC threshold of 1750 cells/mm3 were the most accurate predictors of CD4+ T cell counts of <350 cells/mm3. Therefore, the significant association of TLC with CD4+ T cell count may suggest that TLC could be used as marker for CD4+ T cell count in determining anti-retroviral treatment initiation when CD4+ T cell count is not available particularly in rural settings where laboratory facilities are lacking. [Ethiop. J. Health Dev. 2013;27(1):48-54]