title: Successful implementation of a low-cost method for enumerating CD4+ T lymphocytes in resource-limited settings: the ANRS 12-26 study.
abstract: OBJECTIVE
  To evaluate the feasibility and the relevance of the implementation of an alternative technique to flow cytometry (FC) for enumerating CD4 T cells (Dynabeads; Dynal Biotech, Oslo, Norway), based on quantifying CD4 T cells by epifluorescent microscopy following their isolation using anti-CD4 monoclonal antibody-coated magnetic beads.
  
  
  METHODS
  International multi-center study. Five consecutive runs of dual CD4 T-lymphocyte enumeration by both techniques in six sites in five countries of West Africa.
  
  
  METHODS
  A total of 657 pairs of values of CD4 cell counts were generated by 43 technicians by both FC (TruCount; Becton Dickinson Immunocytometry Systems, San Jose, California, USA) and Dynabeads from blood samples obtained from 301 HIV-infected patients, seen in one (n = 112), two (n = 61), three (n = 75), four (n = 40) or five (n = 13) occasions.
  
  
  RESULTS
  The correlation coefficient between the results of the two techniques was 0.89. The overall systematic difference between Dynabeads and FC was -16 x 10(6) cells/l (P < 10(-4)). The median difference was insignificant (+7.5 cells) for CD4 cell counts below 200 x 10(6) cells/l and increased with CD4 levels. Patients were consistently classified at the threshold of 200 x 106 cells/l by both methods in 88.7% of cases. Among the 74 discrepant pairs of values, only 31 (4.7%) exhibited a difference of more than 100 x 10(6) cells/l.
  
  
  CONCLUSIONS
  Results from Dynabeads and FC were highly correlated. The ability of the alternative method to consistently classify results in agreement with FC, at thresholds of CD4 cell counts relevant for clinical care, was high. The implementation of this low-cost method was easy and successful in the West African context.
authors.affiliation: Centre Muraz, Bobo-Dioulasso, Burkina Faso. diagbouga_serge@hotmail.com
authors.forename: Serge
authors.initials: S
authors.lastname: Diagbouga
authors.forename: Corine
authors.initials: C
authors.lastname: Chazallon
authors.forename: Michel D
authors.initials: MD
authors.lastname: Kazatchkine
authors.forename: Philippe
authors.initials: P
authors.lastname: Van de Perre
authors.forename: André
authors.initials: A
authors.lastname: Inwoley
authors.forename: Souleymane
authors.initials: S
authors.lastname: M'Boup
authors.forename: Mireille Prince
authors.initials: MP
authors.lastname: David
authors.forename: Aoua Thiéro
authors.initials: AT
authors.lastname: Ténin
authors.forename: Robert
authors.initials: R
authors.lastname: Soudré
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Aboulker
authors.forename: Laurence
authors.initials: L
authors.lastname: Weiss
mesh_terms: D000354:Africa, Western / Q000453:epidemiology; D000911:Antibodies, Monoclonal / Q000032:analysis; D018791:CD4 Lymphocyte Count / Q000191:economics / Q000379:methods; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005434:Flow Cytometry / Q000379:methods; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D018189:Immunomagnetic Separation / Q000379:methods; D008856:Microscopy, Fluorescence / Q000379:methods; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D000911:Antibodies, Monoclonal