Usefulness of total lymphocyte count in monitoring highly active antiretroviral therapy in resource-limited settings
Usefulness of total lymphocyte count in monitoring highly active antiretroviral therapy in resource-limited settings
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淋巴细胞总数在监测资源有限环境中高效抗逆转录病毒治疗中的作用
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
R. Wood
中科院分区：
文献类型：
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作者：
M. Badri;R. Wood
目的：评价淋巴细胞总数(TLC)在监测接受高效抗逆转录病毒治疗的HIV感染者中的作用。设计：观察性队列研究。方法：对1995年至2001年在开普敦萨默塞特医院艾滋病病毒临床研究中心进行抗逆转录病毒治疗的患者在第4、8、12和48周时的TLC、CD_4细胞计数和病毒载量的差值(Δ)进行相关性分析。结果：共纳入266例患者。治疗后第4、8、12、48周，TLC增加中位数为30、52、139和219个/L，CD_4细胞数增加中位数为8、48、88和145个×106/L，病毒载量下降中位数分别为−1.6、−2.2、−2.5和−2.7log10拷贝/ml。各对ΔTLC与ΔCD_4细胞计数之间均有显著相关性(r=0.61P<；0.0001)，而ΔTLC与Δ病毒载量之间无显著相关性(r，−0.014；P=0.73)。然而，病毒载量减少的中位数和ΔCD_4细胞计数(r，−0.96；P<；0.0001)和ΔTLC(r，−0.89；P<；0.0001)的中位数增加之间的相关性是显著的。Δ细胞计数斜率为[52.493±0.14(Δ)]。TLC较基线升高或降低的敏感度和特异度分别为83.4%和87.3%。结论：TLC与CD4细胞计数的变化有很好的相关性，在群体水平上与病毒载量的变化有很好的相关性。在资源有限的情况下，TLC可能在廉价监测对高效抗逆转录病毒治疗的免疫应答方面发挥作用。
Objective: To assess the usefulness of total lymphocyte count (TLC) for monitoring HIV-infected patients receiving highly active antiretroviral therapy. Design: Observational cohort study. Methods: Correlation between difference (Δ) from baseline at week 4, 8, 12 and 48 in TLC, CD4 cell count and viral load was determined in patients initiating HAART in phase III clinical trials between 1995 and 2001 at the HIV Clinical Research Unit, Somerset Hospital, Cape Town. Results: The study included 266 patients. At weeks 4, 8, 12 and 48, median increase in TLC was 30, 52, 139 and 219 cells × 106/l, median increase in CD4 cell count was 8, 48, 88, and 145 cells × 106/l, and median decrease in viral load was −1.6, −2.2, −2.5 and −2.7 log10 copies/ml, respectively. The correlation between all pairs of ΔTLC and ΔCD4 cell counts was significant (r, 0.61; P < 0.0001), but between ΔTLC and Δ viral load it was not (r, −0.014; P = 0.73). However, the correlation between median viral load reduction and median increase in both ΔCD4 cell count (r, −0.96; P < 0.0001) and ΔTLC (r, −0.89; P < 0.0001) was significant. The slope of ΔCD4 cell count was [52.493 + 0.14(ΔTLC)]. Sensitivity and specificity of an increase or decrease from baseline in TLC for similar trend in CD4 cell count during follow-up were 83.4% and 87.3% respectively. Conclusion: TLC correlated well with changes in CD4 cell count and at a group level with viral load changes. TLC may have a role in inexpensive monitoring of the immunological response to highly active antiretroviral therapy in a resource-constrained setting.