Revista de SIDA e investigación clínica

Evaluation of Surrogate Markers for Prediction of CD4 Counts in People Living with Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome

Abstract

Jyoti Kotwal, Jasmita Dass, Atul Kotwal, Atul Kakar, Sabina Langer, Amrita Saraf and Achchamma Jacob

India is a developing country where resources are limited. HIV/ AIDS is an ominous public health problem faced by our population and the affordability of patients for 3-6 monthly monitoring of CD4 counts becomes difficult for most patients. The intent of the study was to identify parameters on complete blood counts that can predict a CD4 count of <200/μL. We found that an absolute lymphocyte count obtained by a 5-part cell counter >1250/μL is predictive of a CD4 count <200/μL with a sensitivity and specificity of 87.3% and 70.0% respectively. In addition, a haemoglobin value <11.15g/dL is also a good predictor of the CD4 count <200/μL. The combination of both Hb <11.15g/dl and ALC counter <1250/μL was like a confirmatory test with a specificity of 92.2% and a NPV of 79.5%. Hemoglobin and absolute lymphocyte counts obtained on automated cell counter are robust, cost-effective and easily available methods to follow up PLHA patients and patients on ART. These can effectively predict the CD4 count <200/μL and are especially useful in a developing country where the cost of these tests is one-fifth of flow cytometry.