TOTAL LYMPHOCYTE COUNT AS A SUBSTITUTE TO CD4 COUNT IN MANAGEMENT OF HIV INFECTED INDIVIDUALS IN RESOURCE LIMITED SOCIETY
AbstractBackground: Pakistan is a resource limited society and gold standard parameters to monitor HIV disease activity are very costly. The objective of the study was to evaluate total lymphocyte count (TLC) as a surrogate to CD4 count to monitor disease activity in HIV/AIDS in resource limited society. Methods: This cross sectional study was carried out at HIV/AIDS treatment centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of seven hundred and seventy four (774) HIV positive patients were enrolled in this study, and their CD4 count and total lymphocyte count were checked to find any correlation between the two by using Spearman ranked correlation coefficient. Results: The mean CD4 count was (434.30±269.23), with minimum CD4 count of (9.00), and maximum of (1974.00). The mean total lymphocyte count (TLC) was (6764.0052±2364.02) with minimum TLC (1200.00) and maximum TLC was (20200.00). Using the Pearson’s correlation (r) there was a significant and positive correlation between TLC and CD4 count. (r2=0.127 and p=0.000) at 0.01 level. Conclusion: Our study showed a significant positive correlation between CD4 count and total lymphocyte count (TLC), so TLC can be used as a marker of disease activity in HIV infected patients.Keywords: HIV (human immunodeficiency virus), CD4 count, Total lymphocyte count (TLC).
WHO HIV/AIDS fact sheet updated October 2013.
UN Joint program on HIV/AIDS (2012) Global report: UNAIDS report on the global AIDS epidemic 2012.Available: ttp://www.unaids.org/en/resources/Accessed 2013 Nov 24.
Department of health and human services (2012). Guidelines for use of antiretroviral agents in HIV infected adults. Available: http://aidsinfo.nih.gov/guidelines. Accessed 2013 Dec 28.
Beck EJ, kupek EJ, Gompels MM, Pinching AJ. Correlation between total and CD4 lymphocyte counts in HIV infection: not making the good an enemy of the not so perfect. Int J STD AIDS 1996;6:422–8
Spacek LA, Griswold M, Quinn TC, Moore RD. TLC and hemoglobin combined in an algorithm to initiate the use of HAART in resource limited settings. AIDS 2003;17:1311–7
Kumarasamy N, Mahajan AP, Flamigan TP, Hemalatha R, Mayer KH, Carpenter CC, et al. TLC is a useful tool for the timing of opportunistic infection prophylaxis in India and other resource constrained settings. J Acquir Immune Defic Sndr 2002;319:378–83
Gitura B, Joshi MD, Lule GN, Anzala O. Total Lymphocyte Count as a surrogate marker for CD4+ T cells count in initiating HAART at Kenyatta National Hospital, Nairobi. East Afr Med J 2007;84:466–72
Stebbing J, Sawleshwarkar S, Midailidis C, Jones R, Bower M, Mandiala S, et al. Assessment of the efficacy of total lymphocyte counts as predictors of AIDS defining infections in HIV-1 infected people. Postgrad Med J 2005;81:586–8
Kumarasamy N, Mahajan AP, Flanigan TP, Hemalatha R, Mayer KH, Carpenter CC, et al. Total lymphocyte count (TLC) is a useful tool for the timing of opportunistic infection prophylaxis in India and other resource constrained countries. J Acquir Immune Defic Syndr 2002;31:378–83.
Oudenhoven HP, Meijerink H, Wisaksana R, Oetojo S, Indrati A, van der Ven AJ, et al. Total lymphocyte count is a good marker for HIV-related mortality and can be used as a tool for starting HIV treatment in a resource limited setting. Trop Med Int Health ;16:1372–9.
Moore DM, Awor A, Downing RS, Were W, Solberg P, Tu D, et al. Determining eligibility for antiretroviral therapy in resource-limited settings using total lymphocyte counts, hemoglobin and body mass index. AIDS Res Ther 2007;18:1.
Schreibman T, Friedland G. Use of total lymphocyte count for monitoring response to antiretroviral therapy. Clin Infect Dis 2004;38:257–62.
Susaengrat W, Mitchai M, Leerattanapetch N. Total lymphocyte count: a surrogate marker for predicting CD4+ count in enrolled process for antiretroviral therapy in resource-limited settings. J Med Assoc Thai 2008;91:1514–7.
Srirangaraj S, Venkatesha D. Total lymphocyte count as a tool for timing opportunistic infection prophylaxis in resource-limited settings: a study from India. J Infect Dev Ctries 2010;4:645–9.
15 Mwamburi DM, Ghosh M, Fauntleroy J, Gorbach SL, Wanke CA. Predicting CD4 count using total lymphocyte count: a sustainable tool for clinical decisions during HAART use. Am J Trop Med Hyg 2005;73:58–62
Akinola NO, Olasode O, Adediran IA, Onayemi O, Murainah A, Irinoye O, et al. The Search for a predictor of CD4 cell count continues: total lymphocyte count is not a substitute for CD4 cell count in the management of HIV-infected individuals in a resource-limited setting. Clin Infect Dis 39:579–81.
Mbanya D, Assah F, Ndembi N, Kaptue L. Monitoring antiretroviral therapy in HIV/AIDS patients in resource-limited settings: CD4 counts or total lymphocyte counts? Int J Infect Dis 2007;11:157–60.
Gupta A, Gupte N, Bhosale R, Kakrani A, Kulkarni V, Nayak U, et al. Low sensitivity of total lymphocyte count as a surrogate marker to identify antepartum and postpartum Indian women who require antiretroviral therapy. J Acq Imm Def 2007;46:338–42
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.