Predictive Value of Quantitative Plasma HIV RNA and CD4<SUP>+</SUP> Lymphocyte Count in HIV-Infected Infants and Children

Objectives. To obtain preliminary information on the pharmacokinetic properties, tolerance, safety, and antiviral activity of combination therapy with stavudine and didanosine in children with advanced human immunodeficiency virus (HIV) infection. Methods. Eight children (median age, 6.6 years; range, 2.8 to 12 years) with advanced HIV disease (median CD4+ lymphocyte count at baseline, 42 cells/µL; range, 8 to 553 cells/µL) were treated with stavudine (2 mg/kg per day in two divided doses) and didanosine (180 mg/m2 per day in two divided doses) for 24 weeks. Seven children had histories of prior zidovudine therapy. All children had received stavudine alone for 19 to 33 months before the addition of didanosine to the treatment regimen. Children were assessed clinically and with laboratory studies at baseline, weekly through week 4 of combination therapy, and every 4 weeks thereafter. Results. Analysis of stavudine and didanosine plasma half-life values, clearances, and area under the plasma concentration-versus-time curves revealed no obvious clinical pharmacokinetic interaction between the drugs through study week 12. Combination therapy was well tolerated, and there were no drug-associated clinical or laboratory adverse events. Signs and symptoms of peripheral neuropathy were not observed. All three children with baseline CD4+ lymphocyte counts greater than 50 cells/µL had greater than 20% increases in their counts within the first 12 weeks of therapy; CD4+ lymphocyte count increases were not observed in the other children. Plasma HIV RNA concentrations showed median declines of 0.88 log10 (range, -3.41 log10 to 0.31 log10) and 0.30 log10 (range, -0.63 log10 to 0.89 log10) at study weeks 12 and 24, respectively. Conclusions. Combination therapy with stavudine and didanosine was well tolerated and safe in this small group of children with advanced HIV disease. Plasma HIV RNA concentration declines suggest a favorable effect of therapy on virus load. These findings should be confirmed, and the regimen's clinical efficacy should be examined, in controlled studies of HIV-infected children with less-advanced disease.

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Time-Updated CD4+ T Lymphocyte Count and HIV RNA as Major Markers of Disease Progression in Naive HIV-1-Infected Patients Treated With a Highly Active Antiretroviral Therapy

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/00126334-200307010-00013 ◽

2003 ◽

Vol 33 (3) ◽

pp. 380-386 ◽

Cited By ~ 12

Author(s):

Rodolphe Thiébaut ◽

Geneviève Chêne ◽

Hélène Jacqmin-Gadda ◽

Philippe Morlat ◽

Patrick Mercié ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Disease Progression ◽

T Lymphocyte ◽

Highly Active Antiretroviral Therapy ◽

Lymphocyte Count ◽

Hiv Rna ◽

Highly Active ◽

Hiv 1

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Predictive significance of absolute lymphocyte count and morphology in adults with a new onset peripheral blood lymphocytosis

Journal of Clinical Pathology ◽

10.1136/jclinpath-2014-202545 ◽

2014 ◽

Vol 67 (12) ◽

pp. 1062-1066 ◽

Cited By ~ 7

Author(s):

Ping Sun ◽

Emilia M Kowalski ◽

Calvino K Cheng ◽

Allam Shawwa ◽

Robert S Liwski ◽

...

Keyword(s):

Predictive Value ◽

Lymphocyte Count ◽

Lymphoproliferative Disorder ◽

Absolute Lymphocyte Count ◽

Laboratory Evaluation ◽

Characteristic Analysis ◽

Reactive Process ◽

The Difference ◽

Sensitivity Specificity ◽

Lymphocyte Number

AimsLymphocytosis is commonly encountered in the haematology laboratory. Evaluation of blood films is an important screening tool for differentiating between reactive and malignant processes. The optimal lymphocyte number to trigger morphological evaluation of the smear has not been well defined in the literature. Likewise, the significance of lymphocyte morphology has not been well studied and there are no consensus guidelines or follow-up recommendations available. We attempt to evaluate the significance of lymphocyte morphology and to define the best possible cut-off value of absolute lymphocyte count for morphology review.Methods71 adult patients with newly detected lymphocytosis of 5.0×109/L or more were categorised to either a reactive process or a lymphoproliferative disorder. We performed statistical analysis and morphology review to compare the difference in age, gender, lymphocyte count and morphological features between the two groups. Receiver operating characteristic analysis was performed to determine an optimal lymphocyte number to trigger morphology review.ResultsLymphoproliferative disorders are associated with advanced age and higher lymphocyte count. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lymphocyte morphology as a screening test were 0.9, 0.59, 0.60, 0.58 and 0.71, respectively. The optimal cut-off of lymphocyte number for morphology review was found to be close to 7×109/L.ConclusionsWe found a moderate interobserver agreement for the morphological assessment. ‘Reactive’ morphology was very predictive of a reactive process, but ‘malignant’ morphology was a poor predictor of a lymphoproliferative disorder.

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A Prediction Model of Pretreatment HIV RNA Levels in Naïve Thai HIV-infected Patients: An Application for Resource-limited Settings

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1097 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S434-S434

Author(s):

Nisha Pongpech ◽

Anchalee Avihingsanon ◽

Romanee Chaiwarith ◽

Pacharee Kantipong ◽

David Boettiger ◽

...

Keyword(s):

Prediction Model ◽

Predictive Value ◽

Cd4 Count ◽

High Rate ◽

First Line ◽

Data Set ◽

Factors Associated ◽

Hiv Rna ◽

Hiv Exposure ◽

Rna Levels

Abstract Background The use of abacavir (ABC) and rilpivirine (RPV) in the first-line regimen for naïve HIV-infected patients with pretreatment HIV RNA >100,000 copies/mL is not recommended due to a high rate of treatment failure. If a model could accurately predict pretreatment HIV RNA levels, it would be a useful tool for the selection ABC or RPV in the first-line regimen. Methods Thai HIV-infected adults enrolled in the TREAT Asia HIV Observational Database (TAHOD) and additional patients of Ramathibodi Hospital were eligible if they had an HIV RNA result at the time of antiretroviral therapy initiation. Factors associated with pretreatment HIV RNA <100,000 copies/mL were determined by logistic regression. Based on the results of the final model, a prediction model was created. Results A total of 1,223 patients were included in the analysis. Among those in the derivation data set, median [interquartile range (IQR)] age was 36.3 (30.5–42.9) years, median (IQR) CD4 count was 122 (39–216) cells/mm3, and pretreatment HIV RNA was 100,000 (32,449–229,777) copies/mL. Factors associated with pretreatment HIV RNA <100,000 copies/mL were anemia [odds ratio (OR) 2.05 vs. no anemia; 95% confidence interval (CI) 1.28–3.27], CD4 count >200 cells/mm3 (OR 3.00 vs. CD4 count <200 cells/mm3; 95% CI 2.08–4.33), and non-heterosexual HIV exposure (OR 1.61 vs. heterosexual HIV exposure; 95% CI 1.07–2.43). No AIDS-defining illness (11.5), no anemia (18.5), age <35 years (11), CD4 count >200 cells/mm3 (27), duration of HIV infection >1 year (9), and weight >50 years (11) were included in the clinical prediction tool scores. A score ≥45 yielded a sensitivity of 45.3%, specificity of 76.7%, positive predictive value of 68.1%, and negative predictive value of 56.1% among patients in the derivation. The area under the receiver-operator characteristic curve was 0.655 (95% CI 0.614- 0.696) and 0.600 (95% CI 0.533–0.667) in the derivation and validation patients, respectively. Conclusion Our final prediction model had poor sensitivity and specificity for predicting HIV RNA <100,000 copies/mL. Further study on a larger population with a greater diversity of data variables available is necessary to improve the model. Pretreatment HIV RNA remains necessary before ABC or RPV initiation for naïve Thai HIV-infected patients. Disclosures All authors: No reported disclosures.

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Discontinuation of potent antiretroviral therapy: predictive value of and impact on CD4 cell counts and HIV RNA levels

AIDS ◽

10.1097/00002030-200111090-00005 ◽

2001 ◽

Vol 15 (16) ◽

pp. 2101-2108 ◽

Cited By ~ 28

Author(s):

Linda Ahdieh Grant ◽

Michael J. Silverberg ◽

Herminia Palacio ◽

Howard Minkoff ◽

Kathryn Anastos ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Predictive Value ◽

Hiv Rna ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell ◽

Rna Levels

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Total lymphocyte count as a tool for timing opportunistic infection prophylaxis in resource-limited settings: a study from India

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1011 ◽

2010 ◽

Vol 4 (10) ◽

pp. 645-649 ◽

Cited By ~ 3

Author(s):

Sreenivasan Srirangaraj ◽

Dasegowda Venkatesha

Keyword(s):

Opportunistic Infection ◽

Predictive Value ◽

Lymphocyte Count ◽

Total Lymphocyte Count ◽

Active Tuberculosis ◽

Cd4 Count ◽

Resource Limited Settings ◽

Cd4 Counts ◽

Total Lymphocyte ◽

Resource Limited

Introduction: In resource-limited settings, due to the high cost of CD4 cell count testing, physicians must decide about opportunistic infection (OI) prophylaxis without a laboratory evaluation of HIV stage and level of immune suppression. This study aimed to evaluate the correlation of total lymphocyte count (TLC), an inexpensive laboratory parameter, to CD4 count, and to determine a range of TLC cut-offs for the initiation of OI prophylaxis that is appropriate for resource-limited settings. Methodology: Spearman correlation between CD4 count and TLC was assessed in patients attending the Anti-Retroviral Therapy (ART) centre at Mysore, India. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of various TLC cut-offs were computed for CD4 counts < 200 cells/mm3. Correlation and statistical indices were computed for all patients and for HIV patients with active tuberculosis. Results: Good correlation was noted between the 106 paired TLC and CD4 counts (r = 0.3497).TLC < 1200cells/mm3 had 88.14% sensitivity and 34.78% specificity for CD4 count < 200 cells/mm3. In those patients with active tuberculosis, TLC< 2000cells/mm3 had 95.24% sensitivity and 100% specificity for CD4 count < 200cells/ mm3. Conclusions: TLC could serve as a low-cost tool for determining when to initiate prophylaxis in resource-constrained settings.

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