title: T-cell enumeration from dried blood spots by quantifying rearranged T-cell receptor-beta genes.
abstract: Significant hurdles remain to large-scale implementation of medical interventions in the developing world due to the lack of a modern diagnostic infrastructure. This is especially pertinent to the international roll-out of antiretroviral drugs to treat HIV, which ideally includes a CD4 T-cell count to determine eligibility. We designed a novel technique to estimate mature T-cell numbers by calculating the amount of rearranged T-cell receptor beta genes from dried blood spots of HIV-infected individuals in the United States and Uganda. It was observed that the rearranged T-cell receptor beta count correlated well with total lymphocyte counts from both study populations (Baltimore R=0.602, Uganda R=0.497; p<0.001) and the ability for this measurement to determine antiretroviral initiation was similar to total lymphocyte counts, which can be used to determine eligibility in HIV+children. This technique as well as other dried blood spot based technologies could increase the diagnostic and monitoring capabilities in resource-limited settings.
authors.affiliation: Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. aredd2@jhmi.edu
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Redd
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Ciccone
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.forename: Jeanne C
authors.initials: JC
authors.lastname: Keruly
authors.forename: Anthony
authors.initials: A
authors.lastname: Ndyanabo
authors.forename: Boaz
authors.initials: B
authors.lastname: Iga
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001800:Blood Specimen Collection; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D003906:Developing Countries; D005260:Female; D015333:Gene Rearrangement, beta-Chain T-Cell Antigen Receptor; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014454:Uganda; D014481:United States
chemical_list: D044966:Anti-Retroviral Agents