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

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Background: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.Objective:To examine whether TLC, hemoglobin, and DTH response observed prior to initiation of HAART predict post-HAART clinical response.Design:Prospective cohort study.Participants:873 women in the Women’s Interagency HIV Study.Measurements: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).Results: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.Conclusions: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.

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