Total lymphocyte count can predict HIV progression in children

November 24, 2005

Total lymphocyte count could be a relatively simple, inexpensive way to indicate when antiretroviral therapy (ART) should be started for HIV-infected children in developing countries, concludes a meta-analysis in this week's issue of The Lancet.

In developed countries the decision about when to start ART in adults and children with HIV is based on clinical symptoms, and assessment of the percentage of CD4 T-cells and HIV viral load. However, CD4 counting is too expensive to be made widely available in the countries most affected by the HIV/AIDS pandemic. Total lymphocyte count is a possible alternative. The World Health Organization (WHO) 2003 guidelines recommend total lymphocyte count thresholds for adults and children at which ART can be started in the absence of CD4 cell counts. However, the prognostic value of this marker has not been fully assessed until now.

David Dunn (Medical Research Council, UK) and colleagues combined data from 17 studies looking at total lymphocyte count and disease progression, involving over 3900 children with HIV infection in Europe and USA. The researchers found that total lymphocyte count could predict clinical progression almost as well as CD4 cell percentage. They also found inconsistency between the thresholds of CD4-cell percentage and total lymphocyte count recommended by WHO. The current CD4 threshold means that ART is initiated at a much lower mortality risk than the total lymphocyte count threshold.

Dr Dunn comments: "In this population, total lymphocyte count was a strong predictor of short-term disease progression, being only marginally less predictive than CD4-cell percentage. Confirmatory studies in resource-poor settings are needed to identify the most cost-effective markers to guide initiation of antiretroviral therapy."

He adds: "Our analysis showed an inconsistency between the thresholds of CD4-cell percentage and total lymphocyte count suggested by WHO, in that the former trigger therapy at a much lower mortality risk than the latter. To achieve consistency, either the total-lymphocyte-count thresholds should be increased or the CD4-cell percentage thresholds decreased."

In an accompanying Comment Julio Montaner (University of British Columbia, Vancouver, Canada) states: "Without CD4 testing, even an imperfect addition to clinical assessment will likely result in improved clinical management of paediatric and adult patients infected with HIV in low-income countries where access to ART is expanding relatively rapidly. The available evidence allows a compelling argument to be made for clinical trials and cost-effectiveness analysis to directly assess the performance of TLCs [total lymphocyte count] compared with CD4 counts in countries with limited resources."
-end-
Contact: David Dunn, Senior Statistician, HIV Group, MRC Clinical Trials Unit, 222 Euston Road, London NW1 2DA. T) +44 (0) 20 7670 4739

Comment: Professor Julio SG Montaner, AIDS Research Programme, St Paul's Hospital, University of British Columbia, 667-1081 Burrard Street, Vancouver BC, V6Z 1Y6, Canada. T) +1 604 806 8036 jmontaner@hivnet.ubc.ca

Lancet

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.