APTI ijopp - Indian Journal of Pharmacy Practice

Indian J. Pharm. Pract. 1(2), Jan-Mar, 2009Though these methods are under intensive research, we analyzed various combinations of pairedWHO recognizes the immediate need for a low cost observations of CD4 count and TLC. Based on themethod for scaling up of antiretroviral therapy in clinical utility and best descriptive analysis value wecountries where spreading rate of HIV infection is came to the most suitable CD4 count TLC combination.startling. Monitoring of HAART is a must to minimize The best estimate appears to be that if the TLC count isthe more dangerous possibility of developing drug3 3= 3000cells/mm , the CD4 count will be = 400cells/mmresistant which may cause a catastrophe to the already which is also seen in the ROC curve. Though theless than optimal HAART program in developing and3combination of CD4 count = 200cells/mm & TLC count17,18poor countries.3=2500cells/mm is most clinically relevant in the view ofThis study was conducted in the ART unit (in the WHO recommendation, it lacks reasonable sensitivityDepartment of Medicine) of Government Medical and specificity (56.7 & 76.7 respectively).College Hospital, Thiruvanathapuram, Kerala, India. In this study we had 39 patients with CD4 count less thanThis hospital is funded by NACO in support of WHO.3200cells/mm . When the TLC was compared (thoseEven in such a center CD4 testing is irregular for the3having 1500 cells/mm or less and more than 1500 cells/3patients. Because of the high patient load they may have mm ,close to the WHO recommendation.) only 6 patientsto wait up to 3 months to get their CD4 count done. This3had less than 1500 cells/mm TLC count. Though WHOshows the importance of a reliable surrogate marker for3recommends TLC less than 1200 cells/mm can be usedCD4 count for the better administration of HAART. This3as a predictive for CD4 count less than 200 cells/mm , instudy was designed to check the reliability and clinical this study population, it does not seem to be predictive.utility of TLC as a surrogate marker for CD4 count. Had the WHO recommendation followed, only 15.4% ofAlong with this we also compared out results with WHO patients would have got treated and the rest 84.6% ofrecommendation.patients were left untreated. This result could be due toIn this study, from 68 patients we collected 69 paired the small sample size of the study. But the positiveobservations of CD4 counts and TLC. From this data we correlation of CD4 count with TLC promises furtherfind out the direction of change of TLC count with investigation for appropriate levels of TLC which wouldincrease in CD4 count is positive. In addition to predict more precisely the CD4 level less thancorrelating direction of change between TLC and CD43200 cells/mm . Further more this study was conducted forcount, this study also examined the average change in 6 months which is not enough to recruit more number ofTLC per unit change in CD4 count. In this study patients for the study. Total number of pairedpopulation, the average individual specific mean change observations of CD4 count and TLC in this study is 69,3 3in TLC per 1 CD4 cell/mm was 4.6 cells/mm . a nd on ly 26 pati en ts h ad a pre and post treatment CD4To find out the best sensitivity and specificity correlation count.Table – 1: Goals of HAART 4 *Goals of HAART 4Maximal and durable suppression of viral r eplication (measured by viral load assays)Restor ation and/or preservation of immune functionReduced human immunodeficiency virus (HIV)-related morbidity and mortalityImproved quality of lifeLimit the likelihood of viral resistance to preserve future treatment optionsProvide maximum access to HAART regimens31