457. UTILITY OF AN ALGORITHM OF SURROGATE MARKERS FOR CD4 COUNT TO DETERMINE ELIGIBILITY FOR HAART AMONG HIV INFECTED PREGNANT WOMEN
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Poster for IDSA.pdf (705.4 kB)
  • Background: CD4 count is a marker of HIV disease progression and used to identify patients who qualify for HAART. However CD4 count testing is not always readily available in developing countries. In light of expanding Prevention of Mother to Child Transmission (PMTCT) services there was need to assess Sensitivity, Specificity and the predictive accuracy of clinical algorithms using TLC, WHO Clinical Stages (WCS),Body Mass Index(BMI) and Haemoglobin (HB).

    Methods: This was a retrospective analysis of cross-sectional data from HIV infected pregnant, ARV naive women. Correlation and optimal cut-off points for TLC, BMI, HB and WHO Clinical Stage was calculated using Pearson’s Correlation and linear regression. Sensitivity, Specificity, PPV and NPV were calculated and used to compute Area under the Receiver Operating Curve (ROC) to determine their predictive accuracy.

    Results: Of 362 HIV positive pregnant women, 160(44.5%) had CD4 count <350 cells/mm3. The optimal cut-off points for TLC, HB, and BMI were 850cell/mm3, 8.4g/dl and 15.5kg/m2 with Sensitivity and Specificity of (8% and 97%), (17.4% and 92.5%), and ( 3.7% and 100%) respectively. A 3-step algorithm of WHO Clinical Stages  II&III, TLC≤1000 and HB≤12g/dl; in that order was the most optimal with a 86% Sensitivity, 92% Specificity, 94% PPV, 74% NPV , 78% Youden’s index(J)  and 89% ROC AUC .

    Conclusion:  TLC, HB, WCS and BMI have low predictive accuracy for CD4 count <350cell/mm3. Combination of markers increased the Sensitivity but lowered the Specificity at all TLC thresholds. The above algorithm does not take care of all those who had CD4 count <350cell/mm3 and were classified as WCS I disease.


    Subject Category: J. Clinical practice issues

    Winfred Mwangi, MMED (OBGYN)1, James M'imunya, MMED (OBGYN)2, James Kiarie3 and John Kinuthia, MMED (OBGYN)2, (1)Obstetrics and Gynecology, University of Nairobi /Moi teaching and Referral Hospital, NAIROBI, Kenya, (2)Obstetrics and Gynecology, University of Nairobi , NAIROBI, Kenya, (3)Obstetrics and Gynecology, Kenyatta National Hospital/University of Nairobi, NAIROBI, Kenya

    Disclosures:

    W. Mwangi, None

    J. M'imunya, None

    J. Kiarie, None

    J. Kinuthia, None

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