Total Lymphocyte Count: A Surrogate Marker for Predicting CD4+ Count in Enrolled Process for Antiretroviral Therapy in Resource-Limited Settings
Wattanchai Susaengrat MD*, Manthana Mitchai MSc**, Niramol Leerattanapetch MD*
Affiliation : * The Medicine Department, Khon Kaen Hospital, Khon Kaen ** The Clinical Pathology Department, Khon Kaen Hospital, Khon Kaen
Objective : The purpose of the present study was to evaluate the correlation between total lymphocyte count
(TLC) and CD4+ count and TLC cut-off for predicting CD4+ count < 200 cells/mm3.
Material and Method: The 176-naïve HIV-infected patients from the OPD Khon Kaen Hospital, were recruited
for CD4+ count by flow cytometer and TLC by automated cell counter. All results were analyzed by STATA
statistical software for sensitivity, specificity, PPV, and NPV.
Results : From 176 patients, 61 (34.7%) had CD4+ > 200 cells/mm3 and 115 (65.3%) had CD4+ < 200 cells/
mm3. The ROC curve between CD4+ count and TLC showed TLC < 1,800 cells/mm3 could predict CD4+ count
< 200 cells/mm3 with 78.26% sensitivity, 73.77% specificity, 84.91% PPV, and 64.29% NPV. The sensitivity
was further decreased and specificity was increased when TLC was lower than cut-off.
Conclusion : The presented finding indicates that the appropriated TLC for predicting CD4+ count. < 200
cells/ mm3 was TLC < 1,800 cells/mm3. TLC can also be used as a surrogate marker for starting ARV therapy
in resource limited setting.
Keywords : Total lymphocyte count, Flow cytometer, CD4+ count
