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PREDICTING CD4 COUNT USING TOTAL LYMPHOCYTE COUNT: A SUSTAINABLE TOOL FOR CLINICAL DECISIONS DURING HAART USE

Understanding the total lymphocyte count (TLC)-CD4 count relationship could aide design predictive instruments for making clinical decisions during antiretroviral therapy, especially in underserved resource-poor settings. We performed multiple regression analyses to assess the prediction of CD4 count using TLC on 771 participants with 4,836 visits. In linear and logistic regression TLC, hemoglobin, gender, history of AIDS, and weight predicted CD4 count and CD4 < 200, respectively, before and after highly active antiretroviral therapy (HAART) use. On HAART, the adjusted odds ratios (OR) for TLC < 1500 (optimal TLC cutoff) were 5.1 (95%CI 4.0, 6.5; P < 0.001), and off HAART, 4.6 (95%CI 3.4, 6.2: P < 0.001) with high predictive power. TLC predicts CD4 count and CD4 < 200 cells/µL well during HAART. Including the additional factors improves performance. TLC is simple and inexpensive and can be used in many ways to develop clinical decision-making tools in underserved resource-poor settings during HAART therapy.

Received July 6, 2004. Accepted for publication December 23, 2004.

Financial support: This work was supported by NIH grants PO1 DK 45734-07, MO1 RR 00054, CFAR P30-A-142853, K24-AI-055293, and NIH/Forgarty grant D3TW01083A.

^* Address correspondence to D. Mkaya Mwamburi, Tufts – New England Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA 02111, E-mail: mmwamburi{at}tufts-nemc.org

Authors’ addresses: D. Mkaya Mwamburi and Mayurika Ghosh, Tufts – New England Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, E-mail: mmwamburi{at}tufts-nemc.org and Mghosh{at}tufts-nemc.org. Jim Fauntleroy, Sherwood L. Gorbach, and Christine A. Wanke, Tufts University School of Medicine, Division of Nutrition and Infection, Department of Family Medicine and Public Health, Boston, MA, E-mail: jim.fauntleroy{at}tufts.edu, sherwood.gorbach{at}tufts.edu, and christine.wanke{at}tufts.edu

Reprint requests: D. Mkaya Mwamburi, MD, Tufts – New England Medical Center, Division of Geographic Medicine and Infectious Diseases, 750 Washington Street, Box 41, Boston, MA 02111, Telephone: 617-636-5562, Fax: 617-636-8525, E-mail: mmwamburi{at}tufts-nemc.org.