title: Predictors of low CD4 count in resource-limited settings: based on an antiretroviral-naive heterosexual thai population.
abstract: A barrier to the appropriate provision of antiretroviral therapy to treat immunosuppressed HIV-infected persons in resource-poor countries is identifying who requires treatment. The World Health Organization (WHO) has suggested using a clinical algorithm combined with a total lymphocyte count (TLC) < 1200 cells/mm as a surrogate for a CD4 count less than 200 cells/mm when it is not possible to measure the CD4 count. We evaluated various TLC levels, anemia, and body mass index and compared our data with the WHO criteria to develop a more sensitive algorithm to predict CD4 counts of < 200 cells/mm and < 350 cells/mm in 839 men and women from Thailand infected with HIV-1 subtype E (CRF01_AE). The December 2003 WHO guidelines had a sensitivity of 34.1% in men and 31.8% in women to detect persons with a CD4 count < 200 cells/mm in this HIV-infected population from Thailand. The use of a TLC < 1500 cells/mm or TLC < 2000 cells/mm combined with anemia or WHO stage II infection doubled the sensitivity to detect persons with a CD4 count < 200 (63.0% in men, 68.2% in women) with less than a 6% decrease in specificity.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Costello
authors.forename: Kenrad E
authors.initials: KE
authors.lastname: Nelson
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Lisa
authors.initials: L
authors.lastname: Spacek
authors.forename: Supaluk
authors.initials: S
authors.lastname: Sennun
authors.forename: Sodsai
authors.initials: S
authors.lastname: Tovanabutra
authors.forename: Kittipong
authors.initials: K
authors.lastname: Rungruengthanakit
authors.forename: Vinai
authors.initials: V
authors.lastname: Suriyanon
authors.forename: Ann
authors.initials: A
authors.lastname: Duerr
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology*; D000465:Algorithms; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003365:Costs and Cost Analysis; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D012680:Sensitivity and Specificity; D012727:Sex Characteristics; D013785:Thailand
chemical_list: D019380:Anti-HIV Agents