Predictors of Low CD4 Count in Resource-Limited Settings: Based on an Antiretroviral-Naive Heterosexual Thai Population

Summary: A barrier to the appropriate provision of antiretroviral therapy to treat immunosuppressed HIV-infected persons in resource-poor countries is identifying who requires treatment. The World Health Organization (WHO) has suggested using a clinical algorithm combined with a total lymphocyte count (TLC) <1200 cells/mm³ as a surrogate for a CD4 count less than 200 cells/mm³ when it is not possible to measure the CD4 count. We evaluated various TLC levels, anemia, and body mass index and compared our data with the WHO criteria to develop a more sensitive algorithm to predict CD4 counts of <200 cells/mm³ and <350 cells/mm³ in 839 men and women from Thailand infected with HIV-1 subtype E (CRF01_AE). The December 2003 WHO guidelines had a sensitivity of 34.1% in men and 31.8% in women to detect persons with a CD4 count <200 cells/mm³ in this HIV-infected population from Thailand. The use of a TLC <1500 cells/mm³ or TLC <2000 cells/mm³ combined with anemia or WHO stage II infection doubled the sensitivity to detect persons with a CD4 count <200 (63.0% in men, 68.2% in women) with less than a 6% decrease in specificity.