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dc.contributor.authorGithinji, Nyawira
dc.contributor.authorMaleche-Obimbo, Elizabeth
dc.contributor.authorNderitu, Moses
dc.contributor.authorWamalwa, Dalton C
dc.contributor.authorMbori-Ngacha, DA
dc.date.accessioned2013-03-19T15:48:49Z
dc.date.available2013-03-19T15:48:49Z
dc.date.issued2011-09-30
dc.identifier.citationBMC Infectious Diseases. 2011 Sep 30;11(1):259
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-11-259
dc.identifier.urihttp://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/14700
dc.description.abstractAbstract Background In resource-limited settings, such as Kenya, access to CD4 testing is limited. Therefore, evaluation of less expensive laboratory diagnostics is urgently needed to diagnose immuno-suppression in children. Objectives To evaluate utility of total lymphocyte count (TLC) as surrogate marker for CD4 count in HIV-infected children. Methods This was a hospital based retrospective study conducted in three HIV clinics in Kisumu and Nairobi in Kenya. TLC, CD4 count and CD4 percent data were abstracted from hospital records of 487 antiretroviral-naïve HIV-infected children aged 1 month - 12 years. Results TLC and CD4 count were positively correlated (r = 0.66, p < 0.001) with highest correlation seen in children with severe immuno-suppression (r = 0.72, p < 0.001) and children >59 months of age (r = 0.68, p < 0.001). Children were considered to have severe immuno-suppression if they met the following WHO set CD4 count thresholds: age below 12 months (CD4 counts < 1500 cells/mm3), age 12-35 months (CD4 count < 750 cells/mm3), age 36-59 months (CD4 count < 350 cells/mm3, and age above 59 months (CD4 count < 200 cells/mm3). WHO recommended TLC threshold values for severe immuno-suppression of 4000, 3000, 2500 and 2000 cells/mm3 for age categories <12, 12-35, 36-59 and >59 months had low sensitivity of 25%, 23%, 33% and 62% respectively in predicting severe immuno-suppression using CD4 count as gold standard. Raising TLC thresholds to 7000, 6000, 4500 and 3000 cells/mm3 for each of the stated age categories increased sensitivity to 71%, 64%, 56% and 86%, with positive predictive values of 85%, 61%, 37%, 68% respectively but reduced specificity to 73%, 62%, 54% and 68% with negative predictive values of 54%, 65%, 71% and 87% respectively. Conclusion TLC is positively correlated with absolute CD4 count in children but current WHO age-specific thresholds had low sensitivity to identify severely immunosuppressed Kenyan children. Sensitivity and therefore utility of TLC to identify immuno-suppressed children may be improved by raising the TLC cut off levels across the various age categories.
dc.titleUtility of Total lymphocyte Count as a Surrogate Marker for CD4 counts in HIV-1 infected Children in Kenya
dc.typeJournal Article
dc.date.updated2013-03-19T15:48:50Z
dc.description.versionPeer Reviewed
dc.language.rfc3066en
dc.rights.holderNyawira Githinji et al.; licensee BioMed Central Ltd.


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