Absolute lymphocyte count as a surrogate of CD4+ T Lymphocyte cell count in initiating antiretroviral therapy in HIV-infected Nigerians.

Abstract

Background:Background: Most laboratories in resource-constrained countries, cannot routinely use standard methods to measure markers of disease progression useful in staging and initiation of antiretroviral therapy due to high cost more so with the ongoing reduction of support by the implementing partners. 

The objective of this study is to determine whether Absolute Lymphocyte Count (ALC) can serve as a surrogate for CD4+ T-Lymphocyte Cell Count (CCC) for initiating highly active antiretroviral therapy (HAART) in HIV-infected treatment naïve patients in our setting. Methods: A total of 400 adult Nigerians infected with HIV-1 and who were previously antiretroviral naïve, were recruited into the study at Ahmadu Bello University Teaching Hospital, HIV subspecialty clinic. They were assessed clinically and immunologically and categorized into three clinical stages; A, B, and C according to CDC criteria. Absolute Lymphocyte Count and CCC values were tested for correlation and their validity determined using SPSS version 20 and Chi square statistics.

Results: The patients comprised of 187 males (46.8%) and 213 (53.2%) females. One hundred and eight (27%) of the study subjects were in stage A, 153 (38.5%) in stage B, and 139 (34.8%) in stage C. The mean ALC of stage C subjects is significantly lower than that of stage A subject's p < 0.05. The mean CCC values declines significantly from stage A through B to C p ≈ 0. There was a positive and significantly correlation coefficient between ALC and CCC in stage C; r 0.28, P < 0.05. In all the subjects and in the stages, sensitivity and specificity of a low ALC value to predict a low CCC value were low. 

Conclusion: Absolute Lymphocyte Count is not a reliable and sensitive surrogate of CCC in all HIV infected patients however it is only useful in immunocompromised patients to determine the optimal time to initiate HAART.