Total lymphocyte count, hemoglobin, and delayed-type hypersensitivity as predictors of death and AIDS illness in HIV-1-infected women receiving highly active antiretroviral therapy.
BACKGROUND
Total lymphocyte count (TLC) and hemoglobin level have been suggested as useful and inexpensive parameters to indicate need for HAART in settings in which CD4 cell counts are unavailable. If delayed-type hypersensitivity (DTH) response predicts clinical response in persons using highly active antiretroviral therapy (HAART), it may also prove useful in resource-poor settings.


OBJECTIVE
To examine whether TLC, hemoglobin, and DTH response observed prior to initiation of HAART predict post-HAART clinical response.


METHODS
Prospective cohort study.


METHODS
873 women in the Women's Interagency HIV Study.


METHODS
TLC, hemoglobin, CD4 cell counts, and DTH testing using mumps, candida, and tetanus toxoid antigens, performed within 1 year prior to HAART initiation; death; self-report of initiation of HAART use and AIDS-defining illness (ADI).


RESULTS
Three different multivariate analyses were performed: 2 models that excluded CD4 cell count and assessed TLC at either < 850 or < 1250 cells/microL, and 1 model that excluded TLC and included CD4 < 200 cells/microL. TLC < 850, TLC < 1250, CD4 < 200 cells/microL, anergy to DTH testing, hemoglobin < 10.6 g/dL, and a pre-HAART report of ADI were each consistently independently associated both with death and with incident ADI. Log likelihood chi2 values suggested similar power among the 3 models in predicting both death and incident ADI.


CONCLUSIONS
Pre-HAART TLC, hemoglobin level, anergy to DTH testing, and clinical disease each independently predicted morbidity and death after HAART initiation. These findings support the use of TLC to guide decision-making for HAART initiation and suggest that further study of TLC, hemoglobin level, and DTH responses as an indication to provide HAART may be useful in resource-limited settings.
Anastos
Kathryn
K
Women's Interagency HIV Study, Montefiore Medical Center, Bronx, NY 10467, USA. kanastos@montefiore.org
Shi
Quihu
Q
French
Audrey L
AL
Levine
Alexandra
A
Greenblatt
Ruth M
RM
Williams
Carolyn
C
DeHovitz
Jack
J
Delapenha
Robert
R
Hoover
Donald R
DR
D000163:Acquired Immunodeficiency Syndrome / Q000503:physiopathology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000503:physiopathology*; D006454:Hemoglobins; D006801:Humans; D006968:Hypersensitivity, Delayed; D018655:Lymphocyte Count; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D006454:Hemoglobins