16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

UTILITY OF CLINICAL STAGING, TOTAL LYMPHOCYTE COUNTS, BODY MASS INDEX AND HEMOGLOBIN IN PREDICTING CD4 COUNTS ≤ 200 CELLS/μL IN RURAL UGANDA

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. TuAb0202

D. Moore¹, A. Awor², R. Downing², W. Were², P. Solberg², D. Tu³, R. Hogg⁴, K. Chan⁴, J. Mermin^2
1 British Columbia Centre for Excellence in HIV/AIDS, Entebbe, Uganda, ² US Centers for Disease Control and Prevention, Global AIDS Program, Entebbe, Uganda, ³ Medicins Sans Frontieres - Holland, Vancouver, Canada, ⁴ British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada

BACKGROUND: Previous studies have shown that the accuracy of total lymphocyte counts (TLCs) in predicting CD4 counts ≤ 200 cells/μL can be improved by including hemoglobin (Hb) in diagnostic algorithms. However, no such studies have been conducted in tropical African countries where malaria and other co-infections are common.

METHODS: We conducted an analysis of participants aged > 18 years with WHO clinical stages I, II or III who presented for assessment of antiretroviral therapy (ART)-eligibility in the Home-Based AIDS Care project in Tororo, Uganda. Logistic regression analysis was used to derive TLC thresholds which best predicted CD4 cell counts ≤ 200/μL. The minimum acceptable sensitivity was set as 0.75. Hb and body mass index (BMI) thresholds were used to improve predictive models.

RESULTS: 1830 subjects (75% women, 25% men) had median CD4 counts and TLCs, of 235 and 1840 cells/μL, respectively. A TLC threshold of 1900 cells/μL had the highest aggregated sensitivity (0.75) and specificity (0.65) in predicting CD4 counts ≤ 200/ μL. The best composite model used a lower TLC of 1500 cells/μL to indicate CD4 counts ≤ 200/μL , an upper threshold of 2200 to indicate CD4 counts > 200/μL and Hb values ≤ 12 g/dL to classify those with intermediate TLCs. Using this model (sensitivity of 0.76; specificity of 0.69; positive predictive value 0.64), over 23% of subjects with CD4 counts < 200/μL would not be offered ART and 13% of subjects would be started on ART with CD4 counts > 350 cells/μL. No model using BMI was found with better performance.

CONCLUSIONS: Diagnostic algorithms using TLCs and Hb performed with less accuracy than in previous studies. TLCs may be useful in determining which patients require ART in tropical African countries, but do not precisely predict low CD4 counts.

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2006-08-13
TuAb0202

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