Validity and Reliability of Total Lymphocyte Count as Alternative Biomarker for CD4 Count in the Management of HIV Positive Patients on HAART in Osogbo, Nigeria
B. E. Egbewale1, O. A. Oyedeji2, V. O. Mabayoje3,4*, M. A. Muhibi4, C. A. Akinleye5, A. A. Adejimi1,5
1Department of Community Medicine, College of Health Sciences Osogbo, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
2Department of Paediatrics, College of Health Sciences Osogbo, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
3Department of Haematology and Blood Transfusion, College of Health Sciences Osogbo, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
4Department of Haematology and Blood Transfusion, LAUTECH Teaching Hospital Osogbo, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
5Department of Community Medicine, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria.
DOI: 10.4236/wja.2015.54034   PDF   HTML   XML   3,935 Downloads   5,072 Views   Citations


Introduction: To determine the possibility of utilizing total lymphocyte counts (TLC) instead of CD4 counts in the initiation and management of patients with HIV on highly active antiretroviral therapy (HAART). The commencement of HAART CD4 lymphocytes has been employed in the management HIV. However it has been found that determination of CD4 counts is expensive and somewhat laborious to perform in already overburdened healthcare systems especially in the developing countries. Methodology: Five hundred and three (503) consenting patients already on HAART (commenced at CD4 count < 350 cells/μl) who attended our HIV clinic between February 2014 and February 2015 were enrolled into the study. The patients had already been diagnosed as HIV positive. Kappa statistic was computed as a measure of reliability of TLC. Various cut-off marks for TLC in respect of the CD4 counts were determined in addition to the computation of both sensitivity and specificity. Receiver operating curves (ROC), showing area under the curve indicating agreement in classification, were plotted. Results: Majority of patients were female (73.8%). Most of the patients were in the age range of 25 - 34 years (37.2%). Males were found to be significantly older than females (P < 0.05). Area under the receiver operating curves (ROC) revealed that 4 out of 10 patients would be missed using total lymphocyte count (TLC) as the indicator for commencement of HAART. A low correlation coefficient and Kappa statistic r = 0.18, and K = 0.20 respectively, were observed between TLCs and CD4 counts. Conclusion: Total lymphocyte count is not a suitable alternative to CD4 counts in the management of HIV/AIDS.



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Egbewale, B. , Oyedeji, O. , Mabayoje, V. , Muhibi, M. , Akinleye, C. and Adejimi, A. (2015) Validity and Reliability of Total Lymphocyte Count as Alternative Biomarker for CD4 Count in the Management of HIV Positive Patients on HAART in Osogbo, Nigeria. World Journal of AIDS, 5, 313-321. doi: 10.4236/wja.2015.54034.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hsiung, G.D. (1987) Perspectives on Retroviruses and the Etiologic Agent of AIDS. Yale Journal of Biology and Medicine, 60, 505-514.
[2] Broder, S. and Gallo, R.C. (1984) A Pathogenic Retrovirus (HTLV-III) Linked to AIDS. New England Journal of Medicine, 311, 1292-1297.
[3] May, M.T. and Ingle, S.M. (2011) Life Expectancy of HIV-Positive Adults: A Review. Sex Health, 8, 526-533.
[4] Mabayoje, V.O., Muhibi, M.A., Akindele, R.A., Akinleye, C.A., Mabayoje, P.S. and Babatunde, O.S. (2013) Hepatitis C Virus Co-Infection among People Living with HIV/AIDS in a Nigerian Teaching Hospital. HIV and AIDS Review, 12, 102-105.
[5] Venkataramana, K. (2013) A Study of Biological Markers in HIV Disease Progression and Management in the Highly Active Antiretroviral Therapy (HAART) Era. American Journal of Bioscience and Bioengineering, 1, 24-37.
[6] Hoffman, J., Griensven, J., Colebunders, R. and Keller, M. (2010) The Role of CD 4 Count in HIV Management. HIV Therapy, 4, 27-39.
[7] Février, M., Dorgham, K. and Rebollo, A. (2011) CD4+ T Cell Depletion in Human Immunodeficiency Virus (HIV) Infection: Role of Apoptosis. Viruses, 3, 586-612.
[8] Wynberg, E., Cooke, G., Shroufi, A., Reid, S.D. and Ford, N. (2014) Impact of Point-of-Care CD4 Testing on Linkage to HIV Care: A Systematic Review. Journal of the International AIDS Society, 17, 18809.
[9] Vajpayee, M. and Mohan, T. (2011) Current Practices in Laboratory Monitoring of HIV Infection. Indian Journal of Medical Research, 134, 801-822.
[10] Hosp, M., Lisse, I.M., Quigley, M., Mwinga, A.M., Godfrey-Faussett, P., Porter, J.D., Luo, N., Pobee, J., Wachter, H., McAdam, K.P. and Fuchs, D. (2000) An Evaluation of Low-Cost Progression Markers in HIV-1 Seropositive Zambians. HIV Medicine, 1, 125-127.
[11] Phillips, A.N., Sabin, C.A., Elford, J., Bofill, M., Timms, A., Janossy, G. and Lee, C.A. (1996) Serum β2-Micro- globulin at HIV-1 Seroconversion as a Predictor of Severe Immunodeficiency during 10 Years of Followup. Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology, 13, 262-266.
[12] Beck, E.J., Kupek, E.J., Gompels, M.M. and Pinching, A.J. (1996) Correlation between Total and CD4 Lymphocyte Counts in HIV Infection: Not Making the Good an Enemy of the Not So Perfect. International Journal of STD & AIDS, 7, 422-428.
[13] Gitura, B., Joshi, M.D., Lule, G.N. and Anzala, O. (2007) Total Lymphocyte Count as a Surrogate Marker for CD4+ T Cell Count in Initiating Antiretroviral Therapy at Kenyatta National Hospital, Nairobi. East African Medical Journal, 84, 466-472.
[14] Mbanya, D., Assah, F., Ndembi, N. and Kaptue, L. (2007) Monitoring Antiretroviral Therapy in HIV/AIDS Patients in Resource-Limited Settings: CD4 Counts or Total Lymphocyte Counts? International Journal of Infectious Diseases, 11, 157-160.
[15] Akinola, N.O., Olasode, O., Adediran, I.A., Onayemi, O., Murainah, A., Irinoye, O., Elujoba, A.A. and Durosinmi, M.A. (2004) The Search for Predictor of CD4 Cell Count Continues: Total Lymphocyte Count Is Not a Substitute for CD4 Cell Count in the Management of HIV-Infected Individuals in a Resource-Limited Setting. Clinical Infectious Diseases, 39, 579-581.
[16] Ajayi, A.O., Ajayi, E.A. and Fasakin, K.A. (2009) CD4+ T-Lymphocytes Cell Counts in Adults with Human Immunodeficiency Virus Infection at the Medical Department of a Tertiary Health Institution in Nigeria. Annals of African Medicine, 8, 257-260.
[17] Glynn, J.R., Carael, M., Auvert, B., Kahindo, M., Chege, J., Musonda, R., Kaona, F., Buvé, A. and Study Group on the Heterogeneity of HIV Epidemics in African Cities (2001) Why Do Young Women Have a Much Higher Prevalence of HIV than Young Men? A Study in Kisumu, Kenya and Ndola, Zambia. AIDS, 15, S51-S60.
[18] Angelo, A.L., Angelo, C.D., Torres, A.J., Ramos, A.M., Lima, M., Netto, E.M. and Brites, C. (2007) Evaluating Total Lymphocyte Counts as a Substitute for CD4 Counts in the Follow up of AIDS Patients. Brazilian Journal of Infectious Diseases, 11, 466-470.
[19] Daka, D. and Loha, E. (2008) Relationship between Total Lymphocyte Count (TLC) and CD4 Count among Peoples Living with HIV, Southern Ethiopia: A Retrospective Evaluation. AIDS Research and Therapy, 5, 26.
[20] Balak, D.A., Bissell, K., Roseveare, C., Ram, S., Devi, R.R. and Graham, S.M. (2014) Absolute Lymphocyte Count Is Not Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji. Journal of Tropical Medicine, 2014, Article ID: 715363.

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