Low sensitivity of total lymphocyte count as a surrogate marker to identify antepartum and postpartum Indian women who require antiretroviral therapy.

摘要: Some studies support the use of total lymphocyte count (TLC) as a surrogate marker for CD4 cell to guide antiretroviral therapy (ART) initiation. However most these have focused on nonpregnant adults. In light expanding ART access through prevention mother-to-child transmission (PMTCT)-plus programs in resource-limited settings we assessed sensitivity specificity and positive predictive value (PPV) TLC predicting low counts antepartum postpartum women Pune India. hemoglobin were measured at third trimester delivery 6 9 12 months (PP) cohort 779 HIV-infected women. Optimal cutoff < 200 cells/mm3 was determined via logistic regression where PPV an area under receiver operating characteristic (ROC) curve calculated. Among enrolled 16% had WHO clinical stage 2 or higher 7.9% cells/mm3. Using 2689 TLC-CD4 pairsthe 1200 59% 94% 47% respectively. The ranged between 57% 62% time points evaluated. Addition g/dL 11 increased 74% 92% but decreased 33% 69% compared alone. A combination staging highest lowest other possible combinations predict 350 31% 99% Our data suggest that PP with are likely this low. Between 45% 64% requiring initiation may not be identified by using alone markerfor WHO-recommended is optimal identifying Indian who require ART. (authors)