JAIDS Journal of Acquired Immune Deficiency Syndromes. 35(4):383-392, APRIL 1ST, 2004
PMID: 15097155
Issn Print: 1525-4135
Publication Date: April 1st, 2004
Total Lymphocyte Count, Hemoglobin, and Delayed-Type Hypersensitivity as Predictors of Death and AIDS Illness in HIV-1–Infected Women Receiving Highly Active Antiretroviral Therapy
Kathryn Anastos;Quihu Shi;Audrey French;Alexandra Levine;Ruth Greenblatt;Carolyn Williams;Jack DeHovitz;Robert Delapenha;Donald Hoover;
+ Author Information
From the *Montefiore Medical Center and Lincoln Medical and Mental Health Center, Bronx, NY; †New York Medical College, Valhalla, NY; ‡Cook County Hospital, Rush Medical College, Chicago, IL; §University of Southern California, Los Angeles, CA; ¶University of California at San Francisco, San Francisco, CA; **National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; ††Health Science Center at Brooklyn, NY; ‡‡Howard University Medical Center, Washington, DC; and §§Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ.
Abstract
Total lymphocyte count (TLC) and hemoglobin level have been suggested as useful and inexpensive parameters to indicate need for HAART in settings in which CD4+ cell counts are unavailable. If delayed-type hypersensitivity (DTH) response predicts clinical response in persons using highly active antiretroviral therapy (HAART), it may also prove useful in resource-poor settings.To examine whether TLC, hemoglobin, and DTH response observed prior to initiation of HAART predict post-HAART clinical response.Prospective cohort study.873 women in the Women’s Interagency HIV Study.TLC, hemoglobin, CD4+ cell counts, and DTH testing using mumps, candida, and tetanus toxoid antigens, performed within 1 year prior to HAART initiation; death; self-report of initiation of HAART use and AIDS-defining illness (ADI).Three different multivariate analyses were performed: 2 models that excluded CD4+ cell count and assessed TLC at either <850 or <1250 cells/μL, and 1 model that excluded TLC and included CD4+ <200 cells/μL. TLC <850, TLC <1250, CD4+ <200 cells/μL, anergy to DTH testing, hemoglobin <10.6 g/dL, and a pre-HAART report of ADI were each consistently independently associated both with death and with incident ADI. Log likelihood χ2 values suggested similar power among the 3 models in predicting both death and incident ADI.Pre-HAART TLC, hemoglobin level, anergy to DTH testing, and clinical disease each independently predicted morbidity and death after HAART initiation. These findings support the use of TLC to guide decision-making for HAART initiation and suggest that further study of TLC, hemoglobin level, and DTH responses as an indication to provide HAART may be useful in resource-limited settings.
