The Relationship of Total Lymphocyte Count to CD4 Lymphocyte Counts in Patients Infected with Human Immunodeficiency Virus ARTHUR M. FOURNIER, MD, JAY M. SOSENKO, MD
ABSTRACT: A simple, inexpensive alternative to CD4 counts would facilitate the management of asymptomatic and early symptomatic patients with HIV infection. In this report, a high correlation was found between CD4 counts and total lymphocyte counts calculated from complete blood counts in a cohort of ambulatory HIV -infected patients. Using these data, patients with CD4 counts above and below 500 cells/mm 3 , 200 cells/mm3 , and those with and without symptoms can be identified with a high degree of predictive value. The availability and lower cost of lymphocyte counts make them an attractive alternative to CD4 counts in managing asymptomatic and early symptomatic patients with HIV infection. KEY INDEXING TERMS: CD4 cells; HIV; Lymphocytes. [Am J Med Sci 1992; 304(2): 79-82.]
A
s the natural history of human immunodeficiency virus (HIV) has become better understood, treatment strategies have expanded from the treatment of AIDS to the treatment of early symptomatic and asymptomatic persons with HIV infection. These newer treatment strategies, which emphasize prophylaxis and prevention, require clinical and laboratory staging of the illness. Because interactions between the virus and the CD4 lymphocyte playa central role in the pathophysiology of AIDS, researchers have focused on the CD4 lymphocyte count as a sensitive laboratory marker of the progressive destruction of the immune system. I Studies have demonstrated that the CD4 lymphocyte count correlates well with the clinical progression of HIV infection. I - 3 As a result, measurement of the CD4 From the University of Miami School of Medicine, Miami, Florida. We wish to acknowledge Mr. William Demshok and Ms. Jill Beckman for assistance with data collection, and Ms. Denise BradleyFluellen for production of this manuscript. Correspondence: Arthur M. Fournier, MD, University of Miami School of Medicine, P.O. Box 016960 (R103), Miami, FL 33101. THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
lymphocyte count has become an important part of the clinical management of persons with HIV infection. It is used as a guide not only for prognosis but for the initiation of certain prophylactic and preventive therapies. Thus, zidovudine currently is recommended for asymptomatic patients with CD4 counts of less than 500 cells/mm3 •4 and Pneumocystis Carinii prophylaxis is recommended when CD4 counts fall to around 200 cells/mm 3•3 •5 CD4 counts · require sophisticated technology, are expensive, and are not readily available. As more and more asymptomatic and early symptomatic patients are identified through screening and counseling programs, and as the epidemic spreads among the poor and uninsured, the cost and availability of CD4 counts as a guide to management of HIV infection will become even more problematic. In this article, we present the total lymphocyte count, a simple, inexpensive, and readily available complementary test to CD4 lymphocyte counts that can potentially replace much of the need for CD4 counts used by practicing physicians in the management of asymptomatic HIV patients. Materials and Methods
The Camillus House Health Care Concern is a free standing clinic that provides services to homeless people in Miami. It has been providing HIV counseling, screening, and ambulatory treatment for the past 2 years. As part of the management of HIV patients, simultaneous total lymphocyte counts and CD4 counts have been obtained. These data have been collected with the assessment of the treating physician regarding whether the patient is asymptomatic, early symptomatic, or has AIDS according to CDC criteria. To ensure patient confidentiality, no patient names, chart numbers, or identifying demographic information are included in the database. Data were collected on 65 simultaneous CD4 and total lymphocyte counts from 65 patients. Forty eight were determined to be asymptomatic, 15 were early symptomatic, and 2 were determined to have clinical AIDS. CD4lymphocyte and total lymphocyte counts were performed by a commercial laboratory as a charitable contribution to the clinic.
79
CD4 Lymphocyte Counts in Patients with HIV
2000
Table 1. Sensitivity, Specificity, and Predictive Values of Varying Cut-offs for Total Lymphocyte Counts, in Identifying CD4 Counts of
ABSTRACT: A simple, inexpensive alternative to CD4 counts would facilitate the management of asymptomatic and early symptomatic patients with HIV infection. In this report, a high correlation was found between CD4 counts and total lymphocyte counts calculated from complete blood counts in a cohort of ambulatory HIV -infected patients. Using these data, patients with CD4 counts above and below 500 cells/mm 3 , 200 cells/mm3 , and those with and without symptoms can be identified with a high degree of predictive value. The availability and lower cost of lymphocyte counts make them an attractive alternative to CD4 counts in managing asymptomatic and early symptomatic patients with HIV infection. KEY INDEXING TERMS: CD4 cells; HIV; Lymphocytes. [Am J Med Sci 1992; 304(2): 79-82.]
A
s the natural history of human immunodeficiency virus (HIV) has become better understood, treatment strategies have expanded from the treatment of AIDS to the treatment of early symptomatic and asymptomatic persons with HIV infection. These newer treatment strategies, which emphasize prophylaxis and prevention, require clinical and laboratory staging of the illness. Because interactions between the virus and the CD4 lymphocyte playa central role in the pathophysiology of AIDS, researchers have focused on the CD4 lymphocyte count as a sensitive laboratory marker of the progressive destruction of the immune system. I Studies have demonstrated that the CD4 lymphocyte count correlates well with the clinical progression of HIV infection. I - 3 As a result, measurement of the CD4 From the University of Miami School of Medicine, Miami, Florida. We wish to acknowledge Mr. William Demshok and Ms. Jill Beckman for assistance with data collection, and Ms. Denise BradleyFluellen for production of this manuscript. Correspondence: Arthur M. Fournier, MD, University of Miami School of Medicine, P.O. Box 016960 (R103), Miami, FL 33101. THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
lymphocyte count has become an important part of the clinical management of persons with HIV infection. It is used as a guide not only for prognosis but for the initiation of certain prophylactic and preventive therapies. Thus, zidovudine currently is recommended for asymptomatic patients with CD4 counts of less than 500 cells/mm3 •4 and Pneumocystis Carinii prophylaxis is recommended when CD4 counts fall to around 200 cells/mm 3•3 •5 CD4 counts · require sophisticated technology, are expensive, and are not readily available. As more and more asymptomatic and early symptomatic patients are identified through screening and counseling programs, and as the epidemic spreads among the poor and uninsured, the cost and availability of CD4 counts as a guide to management of HIV infection will become even more problematic. In this article, we present the total lymphocyte count, a simple, inexpensive, and readily available complementary test to CD4 lymphocyte counts that can potentially replace much of the need for CD4 counts used by practicing physicians in the management of asymptomatic HIV patients. Materials and Methods
The Camillus House Health Care Concern is a free standing clinic that provides services to homeless people in Miami. It has been providing HIV counseling, screening, and ambulatory treatment for the past 2 years. As part of the management of HIV patients, simultaneous total lymphocyte counts and CD4 counts have been obtained. These data have been collected with the assessment of the treating physician regarding whether the patient is asymptomatic, early symptomatic, or has AIDS according to CDC criteria. To ensure patient confidentiality, no patient names, chart numbers, or identifying demographic information are included in the database. Data were collected on 65 simultaneous CD4 and total lymphocyte counts from 65 patients. Forty eight were determined to be asymptomatic, 15 were early symptomatic, and 2 were determined to have clinical AIDS. CD4lymphocyte and total lymphocyte counts were performed by a commercial laboratory as a charitable contribution to the clinic.
79
CD4 Lymphocyte Counts in Patients with HIV
2000
Table 1. Sensitivity, Specificity, and Predictive Values of Varying Cut-offs for Total Lymphocyte Counts, in Identifying CD4 Counts of
