title: A Study of Alternate Biomarkers in HIV Disease and Evaluating their Efficacy in Predicting T CD4+ Cell Counts and Disease Progression in Resource Poor Settings in Highly Active Antiretroviral Therapy (HAART) Era.
abstract: BACKGROUND
  Human Immunodeficiency Virus (HIV), the causative agent of AIDS, has been a challenge to medical fraternity since it was first discovered in 1983. About 40 million people are living with HIV infection globally and 99% of the infected people are in south East Asia (SEA). Traditionally, HIV disease and progression, initiation of HAART and response to therapy is monitored by assessing in regular intervals, the T CD4+ cell counts and plasma HIV/RNA viral load. Resource poor, low and low - middle income group countries still have no finances to acquire infrastructure and scientific technology for performing such tests.
  
  
  OBJECTIVE
  Since very few studies are available, they have demonstrated the role of alternate biomarkers that can be used to predict CD4 cell counts and thereby, monitor HIV disease progression and HAART. We aimed to measure certain haematological parameters in HIV seropositive patients and to evaluate their efficacy in predicting TCD4+ cell counts.
  
  
  METHODS
  The study group included 250 HIV seropositive patients with an age range of 18-65 years. 140(56%) males and 110(44%) females were included in the study. Absolute TCD4+cell counts and CD8+T cell counts were measured by using a flow cytometer. (MMWR Recommendations and Reports, 1992) TLC; HB%, AEC and ESR were estimated by using conventional haematological methods. CRP was evaluated by latex agglutination test (Immuno CRP Latex Agglutination Test).
  
  
  RESULTS
  Among the tested haematological markers, a TLC of <1800 cells/mm(3) showed high specificity (100%) in predicting CD4 counts of < 200 cells/mm(3), with an accuracy of 61.46%. Haemoglobin and Absolute Eosinophilic counts showed high specificities of 84.09% and 94.32% respectively in predicting CD4 counts which were below 350 cells/mm(3). ESR with 98.98% sensitivity and AEC which had 83.67% sensitivity were able to predict CD4 counts of <200 cells/mm(3).
  
  
  CONCLUSIONS
  Among the tested biomarkers, it was seen that Absolute Eosinophilic counts of more than 550 cells/mm(3), Blood Haemoglobin which was less than 10 g%, ESR which measured more than 20 mm, CRP values of >1.2 and TLC of <1800 cells/mm(3) could be helpful in predicting CD4 cell counts of < 350 and <200 cells/mm(3).
authors.affiliation: Department of Microbiology, Apollo Health City , Jubilee Hills, Hyderabad, Andhra Pradesh, India .
authors.forename: K V
authors.initials: KV
authors.lastname: Ramana
authors.forename: V
authors.initials: V
authors.lastname: Sabitha
authors.forename: Ratna
authors.initials: R
authors.lastname: Rao
keywords: Alternate biomarkers; HAART; Human Immunodeficiency Virus (HIV)