Total lymphocyte count and World Health Organization pediatric clinical stage as markers to assess need to initiate antiretroviral therapy among human immunodeficiency virus-infected children in Moshi, Northern Tanzania.
Total lymphocyte count and World Health Organization pediatric clinical stage as markers to assess need to initiate antiretroviral therapy among human immunodeficiency virus-infected children in Moshi, Northern Tanzania.
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淋巴细胞总数和世界卫生组织儿科临床分期作为评估坦桑尼亚北部莫希感染人类免疫缺陷病毒的儿童是否需要启动抗逆转录病毒治疗的标志。
DOI：
10.1097/inf.0b013e3181950b7f
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
Cunningham,ColeenK
中科院分区：
文献类型：
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作者：
Johnson,OpemipoO;Benjamin,DanielK;BenjaminJr,DanielK;Schimana,Werner;Tillekeratne,LGayani;Crump,JohnA;Landman,KerenZ;Kinabo,GraceD;Mmbaga,Blandina;Msuya,LevinaJ;Shao,JohnF;Swai,MarkE;Cunningham,ColeenK
背景：世界卫生组织(WHO)建议在资源有限的情况下，当无法获得CD4细胞计数时，单独使用临床分期和淋巴细胞总数来识别需要抗逆转录病毒治疗(ART)的艾滋病毒感染儿童。方法：我们前瞻性地招募了2004年3月至2006年5月在坦桑尼亚莫希乞力马扎罗基督教医学中心儿科传染病诊所接受HIV感染护理的儿童。结果：在214名儿童中，192(89.7%)符合WHO ART启动标准。几种低成本措施确定了在以下程度上符合世卫组织抗逆转录病毒治疗启动标准的个体：世卫组织第3期或第4期的敏感性为87.5%(95%CI，82.8-92.1)，按照定义，特异性为100%(CI，100-100)；WHO建议的先期疾病TLC临界值：敏感性=23.9%(95%CI，17.3-30.5)特异性=78.2%(95%CI，67.3-89.1)。低TLC是一种常见的发现，(50/214；23%)；然而，它并没有提高临床分期在识别严重免疫抑制的2期儿童方面的敏感性或特异性。生长障碍或分离使用淋巴细胞总数不是严重免疫抑制或需要启动抗逆转录病毒治疗的可靠指标。结论：与单独临床分期相比，使用淋巴细胞总数并不能提高识别需要抗逆转录病毒治疗的儿童的能力。在该队列中，低绝对淋巴细胞计数与基于CD4细胞计数的严重免疫抑制无关。
Background:The World Health Organization (WHO) has recommended the use of clinical staging alone and with total lymphocyte count to identify HIV infected children in need of antiretroviral therapy (ART) in resource-limited settings, when CD4 cell count is not available.Methods:We prospectively enrolled children obtaining care for HIV infection at the Kilimanjaro Christian Medical Centre Pediatric Infectious Diseases Clinic in Moshi, Tanzania between March 2004 and May 2006 for this cohort study.Results:One hundred ninety two (89.7%) of 214 children met WHO ART initiation criteria based on clinical staging or CD4 cell count. Several low-cost measures identified individuals who met WHO ART initiation criteria to the following degree: WHO stages 3 or 4 had 87.5%(95% CI, 82.8–92.1) sensitivity and, by definition, 100%(CI, 100–100) specificity; WHO recommended advance disease TLC cutoffs: sensitivity= 23.9%(95% CI, 17.3–30.5) specificity= 78.2%(95% CI, 67.3–89.1). Low TLC was a common finding,(50 of 214; 23%); however, it did not improve the sensitivity or specificity of clinical staging in identifying the severely immunosuppressed stage 2 children. Growth failure or use of total lymphocyte counts in isolation were not reliable indicators of severe immunosuppression or need to initiate ART.Conclusion:The use of total lymphocyte count does not improve the ability to identify children in need of ART compared with clinical staging alone. Low absolute lymphocyte count did not correlate with severe immunosuppression based on CD4 cell count in this cohort.