Total and CD4+ T- lymphocyte count correlation in newly diagnosed HIV patients in resource-limited setting

Abstract

Few clinical settings in resource-limited countries perform CD4+ T-lymphocyte counts required as a baseline test for antiretroviral therapy. We investigated CD4 count in newly diagnosed HIV-infected patients attending our treatment centre and evaluated suitability of total lymphocyte count (TLC) as a surrogate marker for CD4+T-lymphocyte count required as a yardstick for initiating antiretroviral therapy. Usefulness of TLC as a surrogate marker for CD4+T-lymphocyte counts <200, ≤350 and <500cells/µL for HIV-positive patients in our facility was evaluated by 180 pairs of TLC and CD4 counts from 180 newly diagnosed HIV-infected patients and results were compared by linear regression and Spearman's correlation analytical tools. Approximately 72.8% of our patients were diagnosed late as revealed by CD4 count ≤350cells/µL. An overall good correlation was noted between TLC and CD4+Tcell counts (r=0.65, slope=0.69), mean total lymphocyte count of 1.04 ± 0.81, 1.39 ± 1.06 and 1.57 ± 1.13 x 10⁹/L correspond to CD4 lymphocyte counts of <200, ≤350 and < 500cells/µL respectively. When considering initiating HAART for HIV-infected Nigerian clients, TLC can be considered as an inexpensive and easily accessible surrogate marker for predicting CD4+T-lymphocyte at two clinically important CD4 thresholds of CD4 count of ≤350 cells/µL and <500cells/µL.

An Evaluation to Determine the Strongest CD4 Count Covariates during HIV Disease Progression in Women in South Africa

“…Hence, the realisation of managing this continuous clinical covariate influence on the CD4 + cell response would potentially prolong the pre-treatment period and increase the likelihood of delaying patients in experiencing ART-related issues at an early stage of the disease progression. Some of the statistical tools previously used to assess the CD4 + count and covariate associations either were limited or suffered from information loss, for example, analysis of variance (ANOVA) [ 51 , 76 , 77 ], confidence intervals [ 64 ], t-tests [ 58 – 60 ], non-parametric tests [ 33 , 38 ], chi-square tests [ 61 , 78 ], linear regression [ 65 , 79 ], sensitivity, specificity and positive prediction [ 2 , 8 ] and correlation analysis [ 63 , 66 , 80 ]. As such, we also sought to pave the way for other areas such as predictive modelling with streamlined influential clinical covariates that are richer in information preserved in their continuous nature to explain the CD4 + count variation.…”

<p>Covariate random effects on the CD4 count variation during HIV disease progression in women</p>

“…Previously, the associations of these covariates with the CD4 count have been analyzed with statistical methods that ranged from Pearson or Spearmen correlation analysis,50,51 sensitivity, specificity and positive prediction,52,53 linear regression54,55 multivariate regression,18 logistic regression,26,45 Chi-Square tests,28,29,56 non-parametric tests,34,39 independent student t -tests,57,58 confidence intervals,40 the analysis of variance59,60 to generalized estimating equations 27. Their limitations include the inability to give the covariates an opportunity to compete in a single multidimensional model to identify the most influential ones and consequently assessing their effects on the CD4 count variation.…”

Baseline Laboratory Profile of HIV Positive Patients on Antiretroviral Therapy in Jos North Central Nigeria: Implications for Pre-vention, Treatment, Care and Support

“…Nigeria is confronted with a mixed epidemic, driven by low personal risk perception, multiple and concurrent sexual partnership, ineffective and inefficient medical services for sexually transmitted infections, entrenched gender inequalities and inequities, chronic and debilitating poverty, as well as extensive HIV/AIDS stigma and discrimination [5]. Although HIV prevalence has stabilized from 3.6% to 3.4% in Nigeria within a two-year period according to the 2-yearly sentinel surveys, about 220,394 new infections occurred in 2013; less than 10% adults know their HIV status; approximately 3.2 million people live with the virus; and less than 50% of eligible individuals are on antiretroviral therapy [6].…”