Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji
Introduction. An absolute lymphocyte count is commonly used as an alternative to a CD4 count to determine initiation of antiretroviral therapy for HIV-infected individuals in Fiji when a CD4 count is unavailable. Methods. We conducted a retrospective analysis of laboratory results of HIV-infected in...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Journal of Tropical Medicine |
| Online Access: | http://dx.doi.org/10.1155/2014/715363 |
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| author | Dashika A. Balak Karen Bissell Christine Roseveare Sharan Ram Rachel R. Devi Stephen M. Graham |
| author_facet | Dashika A. Balak Karen Bissell Christine Roseveare Sharan Ram Rachel R. Devi Stephen M. Graham |
| author_sort | Dashika A. Balak |
| collection | DOAJ |
| description | Introduction. An absolute lymphocyte count is commonly used as an alternative to a CD4 count to determine initiation of antiretroviral therapy for HIV-infected individuals in Fiji when a CD4 count is unavailable. Methods. We conducted a retrospective analysis of laboratory results of HIV-infected individuals registered at all HIV clinics in Fiji. Results. Paired absolute lymphocyte and CD4 counts were available for 101 HIV-infected individuals, and 96% had a CD4 count of ≤500 cells/mm3. Correlation between the counts in individuals was poor (Spearman rank correlation r=0.5). No absolute lymphocyte count could be determined in this population as a suitable surrogate for a CD4 count of either 350 cells/mm3 or 500 cells/mm3. The currently used absolute lymphocyte count of ≤2300 cells/μL had a positive predictive value of 87% but a negative predictive value of only 17% for a CD4 of ≤350 cells/mm3 and if used as a surrogate for a CD4 of ≤500 cells/mm3 it would result in all HIV-infected individuals receiving ART including those not yet eligible. Weight, CD4 count, and absolute lymphocyte count increased significantly at 3 months following ART initiation. Conclusions. Our findings do not support the use of absolute lymphocyte count to determine antiretroviral therapy initiation in Fiji. |
| format | Article |
| id | doaj-art-7392fc15e47f4461a75d91cbfb700cba |
| institution | Kabale University |
| issn | 1687-9686 1687-9694 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Tropical Medicine |
| spelling | doaj-art-7392fc15e47f4461a75d91cbfb700cba2025-02-03T06:11:22ZengWileyJournal of Tropical Medicine1687-96861687-96942014-01-01201410.1155/2014/715363715363Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in FijiDashika A. Balak0Karen Bissell1Christine Roseveare2Sharan Ram3Rachel R. Devi4Stephen M. Graham5Reproductive Health Clinic, Ministry of Health, P.O. Box 30, Suva, FijiInternational Union Against Tuberculosis and Lung Disease, 75017 Paris, FranceRegional Public Health Service, Hutt Valley 5010, New ZealandDepartment of Health Science, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, FijiReproductive Health Clinic, Ministry of Health, P.O. Box 30, Suva, FijiInternational Union Against Tuberculosis and Lung Disease, 75017 Paris, FranceIntroduction. An absolute lymphocyte count is commonly used as an alternative to a CD4 count to determine initiation of antiretroviral therapy for HIV-infected individuals in Fiji when a CD4 count is unavailable. Methods. We conducted a retrospective analysis of laboratory results of HIV-infected individuals registered at all HIV clinics in Fiji. Results. Paired absolute lymphocyte and CD4 counts were available for 101 HIV-infected individuals, and 96% had a CD4 count of ≤500 cells/mm3. Correlation between the counts in individuals was poor (Spearman rank correlation r=0.5). No absolute lymphocyte count could be determined in this population as a suitable surrogate for a CD4 count of either 350 cells/mm3 or 500 cells/mm3. The currently used absolute lymphocyte count of ≤2300 cells/μL had a positive predictive value of 87% but a negative predictive value of only 17% for a CD4 of ≤350 cells/mm3 and if used as a surrogate for a CD4 of ≤500 cells/mm3 it would result in all HIV-infected individuals receiving ART including those not yet eligible. Weight, CD4 count, and absolute lymphocyte count increased significantly at 3 months following ART initiation. Conclusions. Our findings do not support the use of absolute lymphocyte count to determine antiretroviral therapy initiation in Fiji.http://dx.doi.org/10.1155/2014/715363 |
| spellingShingle | Dashika A. Balak Karen Bissell Christine Roseveare Sharan Ram Rachel R. Devi Stephen M. Graham Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji Journal of Tropical Medicine |
| title | Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji |
| title_full | Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji |
| title_fullStr | Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji |
| title_full_unstemmed | Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji |
| title_short | Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji |
| title_sort | absolute lymphocyte count is not a suitable alternative to cd4 count for determining initiation of antiretroviral therapy in fiji |
| url | http://dx.doi.org/10.1155/2014/715363 |
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