Abstract:
:Pneumocystis jirovecii pneumonia (PCP) prophylaxis may be discontinued when CD4 is > or =200 cells/mm(3) for three months in response to highly active antiretroviral therapy (HAART). Unlike CD4, the total lymphocyte count (TLC) is inexpensive and widely available in resource-constrained countries. Paired TLC and CD4 values of HIV-infected patients attending an HIV clinic from 1998 to 2005 were analysed by Spearman's correlation. The sensitivity, specificity, positive predictive value, negative predictive value and receiver operating characteristics (ROC) using TLC cut-off points between > or =1400 and > or =2000 cells/mm(3) to predict CD4 > or =200 cells/mm(3) were calculated. Next, a cohort of patients who had a TLC < or = 1200 cells/mm(3) and subsequently achieved various TLC cut-off points sustained over three months while receiving HAART was identified. Subjects with subsequent CD4 > or =200 cells/mm(3) in response to HAART were considered to have negligible risk for PCP. There was significant correlation between TLC and CD4 in 46,250 observations from 4307 individuals (r = 0.695, P < or = 0.001). The area under the ROC curve was 0.85 (95% CI = 0.85-0.86). In the historical cohort analysis, 85% and 70% of subjects who achieved TLC > or = 2000 cells/mm(3) and > or =1400, respectively, had a corresponding CD4 > or = 200 cells/mm(3). A sustained rise in TLC in response to HAART may potentially serve as a criterion for discontinuing PCP prophylaxis in resource-constrained countries.
journal_name
Int J STD AIDSjournal_title
International journal of STD & AIDSauthors
Cheung C,Shuter Jdoi
10.1258/ijsa.2009.009090subject
Has Abstractpub_date
2010-06-01 00:00:00pages
406-9issue
6eissn
0956-4624issn
1758-1052pii
21/6/406journal_volume
21pub_type
杂志文章abstract:SUMMARY:Point-of-care microscopy is the gold standard for the diagnosis of vaginal discharge in genitourinary (GU) medicine clinics but not used in primary care settings and reproductive health clinics to which many patients present. In our GU medicine clinic setting, we conducted an audit to assess the utility of micr...
journal_title:International journal of STD & AIDS
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