title: The use of total lymphocyte count as a surrogate for low CD4+ T lymphocyte cell counts among HIV-1-infected women in Tanzania.
abstract: BACKGROUND
  Human Immunodeficiency Virus type 1 (HIV-1) infection leads to a progressive decline in CD4+ T-lymphocyte (CD4) cells. Initiation of prophylaxis against Opportunistic infections in adults (CD4% used for children) and antiretroviral therapy is usually based on CD4 cell counts, but CD4 cell counts measurement is not affordable in most African countries.
  
  
  OBJECTIVE
  To examine whether total lymphocyte counts (TLC) may be used as proxies for low CD4 cell counts.
  
  
  METHODS
  Cross-sectional at baseline when women were pregnant and at least six months postpartum.
  
  
  METHODS
  1,078 HIV-1-infected pregnant women from Dar es Salaam, Tanzania were enrolled in a randomized clinical trial. A series of receiver operator characteristic (ROC) curves were created at baseline and at least 6 months postpartum and among women in WHO Stage 3 and above. The sensitivity and specificity of TLC and hemoglobin in predicting an absolute CD4 count < 200 cells/mm3 were determined for various clinically relevant cut points.
  
  
  RESULTS
  TLC was not a good predictor of low CD4 cell counts during pregnancy or at least six months postpartum as exhibited by low ROC Area Under the Curve (AUCs) of .57 and .62 respectively. No other variable had the ability to predict CD4 < 200 cells/mm3.
  
  
  CONCLUSIONS
  The use of TLC as a proxy for the estimation of low CD4 cell counts in a population of HIV-1-infected adults from sub-Saharan Africa was not substantiated. Inexpensive methods to quantify CD4 cell counts in Africa are needed.
authors.affiliation: MUHAS-Harvard Informatics Training Project, Project. P.O.Box 65015, Dar es Salaam, Tanzania. mgomella@post.harvard.edu
authors.forename: G S
authors.initials: GS
authors.lastname: Mgomella
authors.forename: P A
authors.initials: PA
authors.lastname: Venkatesh
authors.forename: R J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: D
authors.initials: D
authors.lastname: Mwakagile
authors.forename: W
authors.initials: W
authors.lastname: Urassa
authors.forename: K
authors.initials: K
authors.lastname: McIntosh
authors.forename: E
authors.initials: E
authors.lastname: Hertzmark
authors.forename: G
authors.initials: G
authors.lastname: Msamanga
authors.forename: W W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology*; D015497:HIV-1; D006801:Humans; D018655:Lymphocyte Count; D011247:Pregnancy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013636:Tanzania; D055815:Young Adult