Total and CD4+ T- lymphocyte count correlation in newly diagnosed HIV patients in resource-limited setting

Few clinical settings in resource-limited countries perform CD4+ T-lymphocyte counts required as a baseline test for antiretroviral therapy. We investigated CD4 count in newly diagnosed HIV-infected patients attending our treatment centre and evaluated suitability of total lymphocyte count (TLC) as a surrogate marker for CD4+T-lymphocyte count required as a yardstick for initiating antiretroviral therapy. Usefulness of TLC as a surrogate marker for CD4+T-lymphocyte counts <200, ≤350 and <500cells/µL for HIV-positive patients in our facility was evaluated by 180 pairs of TLC and CD4 counts from 180 newly diagnosed HIV-infected patients and results were compared by linear regression and Spearman’s correlation analytical tools. Approximately 72.8% of our patients were diagnosed late as revealed by CD4 count ≤350cells/µL. An overall good correlation was noted between TLC and CD4+T-cell counts (r=0.65, slope=0.69), mean total lymphocyte count of 1.04 ± 0.81, 1.39 ± 1.06 and 1.57 ± 1.13 x 10⁹/L correspond to CD4 lymphocyte counts of <200, ≤350 and < 500cells/µL respectively. When considering initiating HAART for HIV-infected Nigerian clients, TLC can be considered as an inexpensive and easily accessible surrogate marker for predicting CD4+T-lymphocyte at two clinically important CD4 thresholds of CD4 count of ≤350 cells/µL and <500cells/µL. Key words: CD4, total lymphocyte count, highly active antiretroviral therapy, enzyme immunoassay, HIV, flowcytometry.