Correlation Between CD4 Percent And Total Lymphocyte Count (TLC): TLC Thresholds Are Suboptimal For Initiation Of Antiretroviral Therapy In HIV-Infected Nigerian Children.

Total lymphocyte count (TLC) has been proposed by the world health organisation (WHO) as an alternative to percentage of CD4+ T-cell to indicate when antiretroviral therapy (ART) should be started in HIV-infected children in resource-poor setting.Objective: To evaluate the relationship between TLC and CD4 % in HIV-positive children in order to know when to initiation antiretroviral therapy (ART).Methods: A retrospective review of clinical and laboratory data of 120 infected children age 4 months to 15 years were selected at random, seen at paediatrics department of University of Maiduguri teaching hospital, Maiduguri from 2005 to 2008. Based on the base-line paired TLC-CD4%, degree of correlation between these two measures was determined taking into account of different age groups. The yield of the TLC cut-offs suggested in the WHO 2006 guideline for paediatric ART initiation were assessed. Also the reliability of different TLC cut-offs (above and below the WHO threshold for age group) was determined.Results: Data for 112 HIV-positive children with a mean age of 4.62± 2.87 years were completed for analysis. CD4% and the median TLC were higher in infant and younger children. An overall degree of positive correlation between CD4% and TLC was r= 0.68 (p=0.001). Two out of 5 (40%) children who were eligible for ART using CD4% were placed under incorrect immune categories by TLC thresholds. The reliability of shown wide ranges with sensitivity, specificity, PPV and NPV were maximally aggregated in age group d11 months at TLC 3500 for CD4% <25%, in age group 12-35 months at TLC 3500 for CD4% <20% and in age group e36 months TLC 2000 for CD4% <15%.Conclusion: Large number of HIVinfected children in developing countries required ART at presentation. Although good correlations exist between TLC and CD4%, the WHO TLC thresholds for initiating ART is suboptimal. More convenient and less expensive technologies are needed in resource-limited settings