Evaluation of dynabeads and cytospheres compared with flow cytometry to enumerate CD4+ T cells in HIV-infected Ugandans on antiretroviral therapy

被引:17
|
作者
Lutwama, Fred [2 ]
Serwadda, Ronnie [2 ]
Mayanja-Kizza, Harriet [5 ]
Shihab, Hasan M. [1 ]
Ronald, Allan [2 ,3 ]
Kamya, Moses R. [2 ,5 ]
Thomas, David [1 ]
Johnson, Elizabeth [1 ]
Quinn, Thomas C. [1 ,4 ]
Moore, Richard D. [1 ]
Spacek, Lisa A. [1 ]
机构
[1] Johns Hopkins Med Inst, Div Infect Dis, Baltimore, MD 21287 USA
[2] Acad Alliance AIDS Care & Prevent & Infect Dis In, Kampala, Uganda
[3] Univ Manitoba, Winnipeg, MB, Canada
[4] NIAID, NIH, Bethesda, MD 20892 USA
[5] Makerere Univ, Kampala, Uganda
关键词
CD4 lymphocyte counts; HIV-1 viral load; monitoring and evaluation; antiretroviral therapy; resource-limited setting; Uganda;
D O I
10.1097/QAI.0b013e31817bbc3a
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Laboratory-based monitoring of antiretroviral therapy is essential but adds a significant cost to HIV care. The World Health Organization 2006 guidelines support the use of CD4 lymphocyte count (CD4) to define treatment failure in resource-limited settings. Methods: We compared CD4 obtained on replicate samples from 497 HIV-positive Ugandans (before and during ART) followed for 18 months by 2 manual bead-based assays, Dynabeads (Dynal Biotech), and Cytospheres (Beckman Coulter) with those generated by flow cytometry at the Infectious Diseases Institute in Kampala, Uganda. Results: We tested 1671 samples (123 before ART) with Dynabeads and 1444 samples (91 before ART) with Cytospheres. Mean CD4 was 231 cells/mm(3) (SD, 139) and 239 celIS/MM3 (SD, 140) by Dynabeads and flow cytometry, respectively. Mean CD4 was 186 cells/mm(3) (SD, 10 1) and 242 cells/mm(3) (SD, 13 6) by Cytospheres and flow cytometry, respectively. The mean difference in CD4 count by flow cytometry versus Dynabeads were 8.8 cells/mm(3) (SD, 76.0) and versus Cytospheres were 56.8 cells/mm(3) (SD, 85.8). The limits of agreement were -140.9 to 158.4 cells/mm(3) for Dynabeads and -112.2 to 225.8 cells/mm(3) for Cytospheres. Linear regression analysis showed higher correlation between flow cytometry and Dynabeads (r = 0.85, r(2) = 0.73, slope = 0.85, intercept = 28) compared with the correlation between flow cytometry and Cytospheres (r = 0.78, r(2) = 0.60, slope = 0.58, intercept = 45). Area under the receiver operating characteristics curve to predict CD4 <200 cells/mm(3) was 0.928 for Dynabeads and 0.886 for Cylospheres. Conclusion: Although Dynabeads and Cytospheres both underestimated CD4 lymphocyte count compared with flow cytometry, in resource-limited settings with low daily throughput, manual bead-based assays may provide a less expensive alternative to flow cytometry.
引用
收藏
页码:297 / 303
页数:7
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