Relation Between Clinical Profile, CD4 Count and Total Lymphocyte Count in HIV Infected Persons

Author(s): Dr. Jagannadham R

BACKGROUND Total Lymphocyte Count has been advocated to predict CD4 count and to stage HIV disease in the absence of CD4 count. TLC is easily obtained by multiplying percentage lymphocytes by leukocyte count from routine complete blood picture with differential count. In light of its low cost and widespread availability, TLC has already been a useful tool in low-income countries for predicting immunosuppression and triggering opportunistic infection prophylaxis. Recent studies have also demonstrated that TLC alone and in combination with haemoglobin may be useful in determining as to when to initiate antiretroviral therapy. However, there are fewer studies examining the change of TLC in patients on antiretroviral therapy. Earlier studies exist on the usefulness of TLC as a surrogate for CD4 after HAART initiation but TLC has not found universal acceptance as a surrogate for CD4 counts. The latest WHO guidelines no longer recommend TLC as a guide to make treatment decisions in adults and adolescents. METHODS Data for the study was collected from inpatients and outpatients of King George Hospital, Visakhapatnam from December 2016 to September 2018 and from patients who were HIV positive. A total 50 patients were studied, out of which 38 were males and 12 were females. All the patients were clinically examined and subjected to relevant investigations including CD4 Count and TLC. RESULTS Males (38) outnumbered females (12) with the present study. There was no overall significant difference of mean age between male and female patients. Unprotected, multiple sexual contacts are the major risk factors for HIV infection. The common presenting symptoms were fever, anorexia, weight loss, lethargy, cough, diarrhoea and mouth ulcers. Most common opportunistic infections were tuberculosis, chronic diarrhoea and oropharyngeal candidiasis. CD4 Counts were less than 350 cells/μL in majority of patients who were symptomatic. The Total Lymphocyte Counts of 1750 cells/μL and 2450 cells/μL correlated to CD4 counts of 200 cells/μL and 350 cells/μL respectively. CONCLUSIONS There was a significant correlation between CD4 Count and Total Lymphocyte Count. TLC can be used as an effective laboratory tool to monitor disease progression in HIV infected persons where CD4 is not available and in resource poor countries.