0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Total Lymphocyte Count as a Predictor of Absolute CD4+ Count and CD4+ Percentage in HIV-lnfected Persons

Stephen P. Blatt, MD; Catherine R. Lucey, MD; Clifford A. Butzin, PhD; Craig W. Hendrix, MD; Daniel R. Lucey, MD
JAMA. 1993;269(5):622-626. doi:10.1001/jama.1993.03500050100034.
Text Size: A A A
Published online

Objective.  —To determine whether the total lymphocyte count (TLC) accurately predicts a low absolute CD4+ T-cell count and CD4+ percentage in persons infected with human immunodeficiency virus (HIV).

Design.  —Retrospective analysis of data collected in the US Air Force HIV Natural History Study.

Setting.  —Military medical center that performs annual medical evaluation of all HIV-infected US Air Force personnel.

Patients.  —A total of 828 consecutive patients with no prior history of zidovudine use, evaluated from January 1985 through July 1991. For patients with multiple observations over time, a single data point within each 6-month interval was included in the analysis (N=2866).

Measurements and Main Results.  —The sensitivity, specificity, and likelihood ratio (LR) of the TLC, in the range of 1.00×109/L to 2.00×109/L, in predicting an absolute CD4+ T-cell count less than 0.20×109/L or a CD4+ percentage less than 20% were calculated. In addition, the LR and pretest probability of significant immunosuppression were used to calculate posttest probabilities of a low CD4+ count for a given TLC value. The LR of the TLC in predicting an absolute CD4+ count <0.20×109/L increased from 2.4(95% confidence interval, 2.2 to 2.5) for all TLCs less than 2.00×109/L, to 33.2 (95% confidence interval, 24.1 to 45.7) for all TLCs less than 1.00×109/L. The specificity for this prediction increased from 57% to 97% over this range. The LR also increased from 1.4(95% confidence interval, 1.3 to 1.6) for all TLCs less than 2.00×109/L to 9.7 (95% confidence interval, 7.1 to 13.1) for all TLCs less than 1.00×109/L in predicting a CD4+ percentage less than 20%.

Conclusions.  —The TLC, between 1.00×109/L and 2.00×109/L, appears to be a useful predictor of significant immunosuppression as measured by a CD4+ T-cell count less than 0.20×109/L in HIV-infected persons. The LR for a given TLC value and the pretest probability of immunosuppression can be used to determine the posttest probability of significant immunosuppression in individual patients. For example, in a patient with a TLC less than 1.50×109/L and a pretest probability of 16%, the posttest probability of a low CD4+ T-cell count increases to 53%. In contrast, a TLC greater than 2.00×109/L in an individual with a pretest probability of 30% will decrease the posttest probability of a low CD4+ T-cell count to less than 4%. Physicians should find these data useful to help predict the risk for opportunistic infection among HIV-infected persons who present with syndromes that are potentially compatible with opportunistic infection but who have not had recent or prior CD4+ T-cell analysis.(JAMA. 1993;269:622-626)

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

179 Views
0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
×
brightcove.createExperiences();