Total lymphocyte count and World Health Organization pediatric clinical stage as markers to assess need to initiate antiretroviral therapy among human immunodeficiency virus-infected children in Moshi, Northern Tanzania.
BACKGROUND
The World Health Organization (WHO) has recommended the use of clinical staging alone and with total lymphocyte count to identify HIV infected children in need of antiretroviral therapy (ART) in resource-limited settings, when CD4 cell count is not available.


METHODS
We prospectively enrolled children obtaining care for HIV infection at the Kilimanjaro Christian Medical Centre Pediatric Infectious Diseases Clinic in Moshi, Tanzania between March 2004 and May 2006 for this cohort study.


RESULTS
One hundred ninety two (89.7%) of 214 children met WHO ART initiation criteria based on clinical staging or CD4 cell count. Several low-cost measures identified individuals who met WHO ART initiation criteria to the following degree: WHO stages 3 or 4 had 87.5% (95% CI, 82.8-92.1) sensitivity and, by definition, 100% (CI, 100-100) specificity; WHO recommended advance disease TLC cutoffs: sensitivity = 23.9% (95% CI, 17.3-30.5) specificity = 78.2% (95% CI, 67.3-89.1). Low TLC was a common finding, (50 of 214; 23%); however, it did not improve the sensitivity or specificity of clinical staging in identifying the severely immunosuppressed stage 2 children. Growth failure or use of total lymphocyte counts in isolation were not reliable indicators of severe immunosuppression or need to initiate ART.


CONCLUSIONS
The use of total lymphocyte count does not improve the ability to identify children in need of ART compared with clinical staging alone. Low absolute lymphocyte count did not correlate with severe immunosuppression based on CD4 cell count in this cohort.
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
Opemipo O
OO
Johnson
Daniel K
DK
Benjamin
Daniel K
DK
Benjamin
Werner
W
Schimana
L Gayani
LG
Tillekeratne
John A
JA
Crump
Keren Z
KZ
Landman
Grace D
GD
Kinabo
Blandina
B
Mmbaga
Levina J
LJ
Msuya
John F
JF
Shao
Mark E
ME
Swai
Coleen K
CK
Cunningham
D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance; D007223:Infant; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013636:Tanzania; D014944:World Health Organization
D019380:Anti-HIV Agents; D015415:Biomarkers