Introduction: In HIV infected individuals, CD4 T cell counts along with viral load remains the mainstay for assessing the immune status and for clinical management. As these tests are expensive and not easily available, absolute lymphocyte count (ALC) has been suggested to reflect the CD4 counts. This can then be used to predict the immune status for initiation of chemoprophylaxis for opportunistic infections in resource limited settings. Objectives: This study was undertaken to evaluate ALC as an alternative marker for CD4 counts in HIV infected patients and to assess its clinical utility. Materials and Methods: Haematological parameters and CD4 counts for all HIV positive cases from January 2016 to August 2018 was assessed. The Beckman Counter FC 500 flow cytometer was used for CD4 counts and Sysmex XE 2100 for haematological profile. Spearman correlation and receiver operating curve (ROC) were used for calculating sensitivity, specificity and positive predictive values. Results: Sensitivity, specificity and positive predictive value of ALC < 1200 cells/µl to predict CD4 < 200 cells/µl, was found to be 92%, 53% and 64% respectively. There is a positive correlation between CD4 count and ALC of 0.655 which is statistically significant (p < 0.05). Conclusion: Our data shows a good correlation between ALC and CD4 cell counts, with ALC < 1210 cells/µl cut off to have the maximum sensitivity for predicting CD4 count < 200 cells/µl. Hence, ALC can be considered as an economical and easily available substitute in prediction of low CD4 counts.

Keywords: Absolute lymphocyte count; CD4 counts; HIV.