Comparison of 5 Flow Cytometric Immunophenotyping Systems for Absolute CD4+ T-Lymphocyte Counts in HIV-1-Infected Patients Living in Resource-Limited Settings

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Enumeration of CD4+ T lymphocytes is important in management of HIV-infected patients. However, CD4 testing by current gold standard bead-based flow cytometer (FCM) system is expensive for developing countries. This study compared 2 affordable volumetric FCMs with the 3 predicate FCM systems. CD4+ T-lymphocyte counts on blood samples from 150 HIV-1-infected Thai patients were determined in parallel by 5 FCM systems: the 2 single-platform volumetric FCM systems, Guava and CyFlowgreen; the 2 standard single-platform bead-based systems (2-color FACSCount and the TriTEST/TruCOUNT tube using a FACSCalibur FCM); and the dual-platform TriTEST system. Correlation and agreement were analyzed using linear regression and Bland-Altman analysis. Results from these 2 volumetric systems gave similar results and excellent correlation: R2 > 0.93; mean biases ranged from +6.3 to +24.1 cells per microliter more for the Guava. In contrast, the CyFlowgreen showed the lowest values with R2 > 0.97; mean biases ranged from −9.8 to −27.6 cells per microliter. This indicates that the absolute CD4+ T-lymphocyte counts determined by CyFlowgreen are

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