Title: Correlation of CD4 T Cell Count with Absolute Lymphocyte Count and Haemoglobin Levels in Human Immunodeficiency Virus Diseases
Authors: Dr Mukta Meel, Dr Sunita Bhargava, Dr Mukesh Kumar
DOI: http://dx.doi.org/10.18535/jmscr/v3i12.45
Aim: Depletion of CD4 cell count is a hallmark of disease progression in AIDS. CD4 cell count is essential for physicians to decide about the timing of initiation of antiretroviral therapy (ART) and for prophylaxis of opportunistic infections. WHO has recommended that, absolute lymphocyte count (ALC) of ≤1200/μL can substitute CD4 cell count of ≤200/μL in resource-constrained countries throughout the world. Materials and Methods: This study was undertaken to know whether there is a correlation between CD4 cell count and ALC as well as haemoglobin in HIV-infected individuals. A single sample of blood was withdrawn for ALC and CD4 cell count. The samples received from December 1, 2011 to December 31, 2013 were analyzed. Results: A total of 500 samples were collected from 500 patients and were analyzed. Results revealed that male:female ratio was 1.98 :1 and their age ranged from 13 to 70 years. The median ALC was 1295 cells/μL, whereas the CD4 cell count ranged from 21 to 452. The correlation coefficient between ALC and CD4 cell count was significant (0.348). There were 207 patients with an ALC of ≤1200/μL of whom 81.16 % patients had CD4 cell count ≤ 200/μL (true positive) and 18.84% had CD4 cell count > 200/μL (false positive). There were 293 patients with an ALC of >1200/μL of whom 60.41% had CD4 cell count > 200/μL (true negative) and 39.59% had CD4 cell count ≤ 200/μL (false negative). Taking ALC of ≤1200/μL as a predictor of CD4 cell count ≤ 200/μL, the sensitivity of the test was 59.15% and specificity was 81.94%. The positive predictive value was 81.15%, negative predictive value was 60.40%, and Out of five hundred cases ALC and Hb could be correlated with CD4 cell count in 243 cases, amongst which 138 cases had ALC ≤ 1200 cells/mm3, Hb ≤ 10 gm% and CD4 cell count ≤ 200 cells/mm3, with accuracy of 81.66%. Conclusion: We found that an ALC of ≤ 1500/μL has higher sensitivity (80.63%) for a CD4 cell count of ≤ 200/μL. The ALC was found to be significantly cost-effective in our setup but chances of missing out patients requiring ART was 1 in 5 using the WHO guidelines. KEY WORDS: Absolute lymphocyte count, AIDS, CD4 cell count, HIV, India 1. UNAIDS: Global Report for Epidemic of AIDS; Geneva, 2010. 2. Buseri FI, Mark D, Jeremiah ZA: Evaluation of Absolute Lymphocyte Count as a Surrogate marker for CD4+ cell count for the Initiation of Antiretroviral Therapy (ART) in Resource-limited Settings. International Journal of Biomedical Laboratory Science 1(2); 44-49, 2012. 3. Kakar A, Beri R, Gogia A, Byotra SP, Prakash V, Kumar S, Bhargava M: Absolute lymphocyte count: A cost-effective method for monitoring HIV-infected individuals. Ind J PatholMicrobiol 54; 107-111, 2011. 4. Srirangaraj S and Venkatesha D: Absolute lymphocyte count as a surrogate marker for CD4 counts after six months of HAART initiation in a resource-limited setting in India. Indian J Med Res 135; 895-900, 2012. 5. Flanigan TP, Kumarasamy N, Mahajan AP, Hemalatha R, Mayer KH, Carpenter CC, Thyagarajan SP, Soloman S: 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 DeficSyndr 31(4); 378-83, 2002. 6. Costello C: Haematological abnormalities in human immunodeficiency virus (HIV) disease. J ClinPathol 41; 711-715, 1988. 7. Sen S, Vyas A, Sanghi S, Shanmuganandan K, Gupta RM, Kapila K, Praharaf AK, Kumar S, Batra RB: Correlation of CD4+ T cell count with total lymphocyte count and haemoglobin in human immunodeficiency virus type-1 diseases. Medical J Armed Force India 67; 15-20, 2011. 8. Losina E, Yazdanpanah Y, Deuffic-Burban S, Wang B, Wolf LL, Messou E, Gabillard D, Seyler C, Freedberg KA, Anglaret X: The Independent Effect of Highly Active Antiretroviral Therapy on Severe Opportunistic Disease Incidence and Mortality in HIV infected Adults in Cote d’Ivoire. AntivirTher 12(4); 543-551, 2007. 9. Fahey JL, Taylor JMG, Detels R, Prince H, Weaver M: The prognostic value of cellular and serologic markers in infection with human immunodeficiency virus type 1. N Engl J Med 322; 166-72, 1990. 10. Phillips AN, Elford J, Sabin C, Bofill M, Janossy G, Lee CA: Immunodeficiency and the risk of death in HIV infection. J Am Med Assoc 268; 2662-66, 1992. 11. WHO: Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach -2003 revision. Switzerland, WHO Press; 2004. 12. Obirikorang C and Yeboah FA: Blood haemoglobin measurement as a predictive indicator for the progression of HIV/AIDS in resource-limited setting. Journal of Biomedical Science 16; 102, 2009.Abstract
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