CD4 Variability in Malawi: Implications for Use of a CD4 Threshold of 500 Cells/mm3 Versus Universal Eligibility for Antiretroviral Therapy

摘要: Background.  Given the uncertainty about ability of a single CD4 count to accurately classify patient as antiretroviral therapy (ART) eligible, we sought understand extent which variability results in misclassification at threshold 500 cells/mm3. Methods.  We performed prospective study Malawian human immunodeficiency virus-infected, ART-naive, World Health Organization (WHO) stage 1 or 2, nonpregnant adults. counts were daily for 8 days. We fit Bayesian linear mixed-effects model log-transformed cell data. used Monte Carlo approximations estimate rates different observed values CD4. The rate was calculated based on conditional probability true given geometric mean measurements. Results.  Fifty patients enrolled from 2 sites. median age 33.5 years (interquartile range, 27.5-40.0) and 34 (68%) female. Misclassification <1% when ≤250 ≥750 Rates high between 350 650 cells/mm3, particularly measurement (up 46.7%). Conclusions.  Our data show that ART eligibility highest risk are range 350-650 Given benefits early ART, countries should weigh costs complexity testing using cell/mm3 against cost savings public health universal eligibility.