title: Performance of absolute CD4+ count in predicting co-infection with human T-lymphotropic virus type 1 in antiretroviral-naive HIV-infected patients.
abstract: Early identification of patients co-infected with HIV and human T-lymphotropic virus type 1 (HTLV-1) is essential to improve care, as CD4+ T-cell counts have been revealed to be an unreliable laboratory parameter to monitor HIV infection in co-infection. Unfortunately, HTLV-1 testing is not currently available in sub-Saharan Africa. We conducted this study to determine the performance of absolute CD4+ T-cell count estimation in guiding the clinical suspicion of co-infection. A cross-sectional survey was conducted in antiretroviral-naïve HIV (AN-HIV) patients attending an HIV outpatient clinic in Maputo city, Mozambique. Seven hundred and one AN-HIV patients were enrolled in the study. The prevalence of HTLV-1 co-infection was 4.5% (95% confidence interval [CI] 3.0-6.0%). Logistic regression analysis showed that CD4+ T-cell count was an independent predictor of co-infection (P value: 0.000). The performance of absolute CD4+ T-cell counts in predicting co-infection was higher in symptomatic HIV patients when compared with asymptomatic HIV patients. The best performance was achieved with the cut-off of CD4+ count of 500 cells/mm(3), which gave sensitivity, specificity, positive and negative predictive values of 54.2%, 87.2%, 24.0% and 96.2%, respectively. In conclusion, our data provide evidence that the absolute CD4+ T-cell count is of moderate accuracy in guiding the clinical suspicion of co-infection in AN-HIV and its implementation could improve the care provided to a significant number of HIV patients in Mozambique.
authors.affiliation: Instituto Nacional de Saúde, PO Box 264, Maputo, Mozambique. esamogudo@yahoo.com.br
authors.forename: E S
authors.initials: ES
authors.lastname: Gudo
authors.forename: N B
authors.initials: NB
authors.lastname: Bhatt
authors.forename: O
authors.initials: O
authors.lastname: Augusto
authors.forename: C
authors.initials: C
authors.lastname: Semá
authors.forename: W
authors.initials: W
authors.lastname: Savino
authors.forename: O C
authors.initials: OC
authors.lastname: Ferreira
authors.forename: I V
authors.initials: IV
authors.lastname: Jani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology; D060085:Coinfection / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology* / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification; D015498:HIV-2 / Q000302:isolation & purification; D015490:HTLV-I Infections / Q000453:epidemiology / Q000276:immunology* / Q000821:virology*; D015368:Human T-lymphotropic virus 1 / Q000302:isolation & purification*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000473:pathology
chemical_list: D044966:Anti-Retroviral Agents