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Total lymphocyte count as a surrogate marker to predict CD4 count in human immunodeficiency virus-infected children:
Yuming Wang1, Yuqian Li, Chongjian Wang
1Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
Insights
Total lymphocyte count (TLC) can predict CD4 counts in children with human immunodeficiency virus (HIV). This finding is crucial for monitoring treatment efficacy in resource-limited settings.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Human immunodeficiency virus (HIV) infection significantly impacts lymphocyte counts in children.
- Monitoring CD4 counts is essential for assessing HIV disease progression and treatment effectiveness.
- Access to regular CD4 count monitoring can be challenging in resource-limited settings.
Purpose of the Study:
- To evaluate the correlation between total lymphocyte count (TLC) and CD4 count in HIV-infected children.
- To determine if TLC can serve as a surrogate marker for predicting CD4 count.
- To assess the predictive value of TLC for CD4 count before and during highly active antiretroviral therapy (HAART).
Main Methods:
- Retrospective study involving 576 HIV-infected children in China.
- Spearman rank order correlation and receiver-operating characteristic (ROC) analysis were employed.
- TLC and CD4 counts were analyzed pre-HAART and at 6 and 12 months of HAART.
Main Results:
- A significant positive correlation was observed between TLC and CD4 count across all time points (pre-HAART, 6 months, and 12 months HAART; P = 0.001).
- Pre-HAART: TLC ≤ 2600 cells/mm³ predicted CD4 count ≤ 350 cells/mm³ with 82.9% sensitivity and 79.6% specificity.
- During HAART: Optimal prediction of CD4 count ≤ 350 cells/mm³ was achieved with TLC ≤ 2400 cells/mm³ at 6 months (73.6% sensitivity, 74.1% specificity) and 12 months (81.7% sensitivity, 76.5% specificity).
Conclusions:
- Total lymphocyte count (TLC) is a reliable surrogate marker for predicting CD4 count in HIV-infected children.
- TLC can be effectively used for monitoring HIV disease progression and treatment response in resource-limited settings.
- This approach can improve patient management and reduce healthcare costs where advanced monitoring is scarce.
Abstract:
A retrospective study was conducted, and 576 human immunodeficiency virus-infected children with total lymphocyte count (TLC) and CD4 count were recruited from China. Spearman rank order correlation and receiver-operating characteristic were used. An overall positive correlation was noted between TLC and CD4 count (prehighly active antiretroviral therapy [pre-HAART], r = 0.789, 6 months of HAART, r = 0.642, 12 months of HAART, r = 0.691, P = 0.001). TLC ≤ 2600 cells/mm(3) predicted a CD4 count of ≤ 350 cells/mm(3) with 82.9% sensitivity, 79.6% specificity pre-HAART. Meanwhile, the optimum prediction for CD4 count of ≤ 350 cells/mm(3) was a TLC of ≤ 2400 cells/mm at 6 months (73.6% sensitivity and 74.1% specificity) and 12 months (81.7% sensitivity and 76.5% specificity) of HAART. TLC can be used as a surrogate marker for predicting CD4 count of human immunodeficiency virus-infected children before and during HAART in resource-limited countries.
