Absolute lymphocyte count is not a suitable alternative to CD4 count for determining initiation of antiretroviral therapy in fiji.
Introduction. An absolute lymphocyte count is commonly used as an alternative to a CD4 count to determine initiation of antiretroviral therapy for HIV-infected individuals in Fiji when a CD4 count is unavailable. Methods. We conducted a retrospective analysis of laboratory results of HIV-infected individuals registered at all HIV clinics in Fiji. Results. Paired absolute lymphocyte and CD4 counts were available for 101 HIV-infected individuals, and 96% had a CD4 count of ≤500 cells/mm(3). Correlation between the counts in individuals was poor (Spearman rank correlation r = 0.5). No absolute lymphocyte count could be determined in this population as a suitable surrogate for a CD4 count of either 350 cells/mm(3) or 500 cells/mm(3). The currently used absolute lymphocyte count of ≤2300 cells/μL had a positive predictive value of 87% but a negative predictive value of only 17% for a CD4 of ≤350 cells/mm(3) and if used as a surrogate for a CD4 of ≤500 cells/mm(3) it would result in all HIV-infected individuals receiving ART including those not yet eligible. Weight, CD4 count, and absolute lymphocyte count increased significantly at 3 months following ART initiation. Conclusions. Our findings do not support the use of absolute lymphocyte count to determine antiretroviral therapy initiation in Fiji.
Reproductive Health Clinic, Ministry of Health, P.O. Box 30, Suva, Fiji.
Dashika A
DA
Balak
International Union Against Tuberculosis and Lung Disease, 75017 Paris, France ; The University of Auckland, Auckland 1020, New Zealand.
Karen
0000-0002-2026-6311
K
Bissell
Regional Public Health Service, Hutt Valley 5010, New Zealand.
Christine
0000-0002-9118-8082
C
Roseveare
Department of Health Science, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
Sharan
S
Ram
Reproductive Health Clinic, Ministry of Health, P.O. Box 30, Suva, Fiji.
Rachel R
RR
Devi
International Union Against Tuberculosis and Lung Disease, 75017 Paris, France ; Centre for International Child Health, Royal Children's Hospital, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia.
Stephen M
SM
Graham