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JAIDS Journal of Acquired Immune Deficiency Syndromes:
Epidemiology and Social Science

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

Costello, Caroline MPH*†; Nelson, Kenrad E MD‡; Jamieson, Denise J MD*; Spacek, Lisa MD, PhD‡; Sennun, Supaluk MS, RN§; Tovanabutra, Sodsai PhD∥; Rungruengthanakit, Kittipong MS§; Suriyanon, Vinai MD§; Duerr, Ann MD, PhD, MPH*

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Abstract

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.

© 2005 Lippincott Williams & Wilkins, Inc.

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