Nowadays, about 34 million people in the world live with HIV/AIDS, from which 7 of each 10 infected are between 15 and 49 years old according to recent reports of UNAIDS and United Nations (1). From 2001 it has been highlighted a decrease in the incidence of this disease in regions such as the Caribbean (42%) and Sub-Saharan Africa (25%). However, in other regions of the world the incidence since the 2000s, has been increasing, specifically in Middle East and North Africa as well as Eastern Europe and Central Asia. So, this pandemic continues to be a concerning issue for the sanitary and scientific community, generating a necessity of unifying efforts to increase the awareness of the risks, adequate prevention strategies and therapeutic assistance (2).
The recommendations of the World Health Organization (3) towards the remaining global institutions the deal with providing the initial anti-retroviral management as well as the following up of the patients are based in the absolute measurement of the number of CD4 lymphocytes, which is currently obtained through flow cytometry. Nevertheless, the technology that is required for this test is not only expensive in relation with the equipment required but because it requires highly qualified personnel. as a consequence, limited access is found in low income countries that do not possess the technological resources or the specialized personnel to perform the test (4).
Different strategies to overcome the difficulty off limited access to flow cytometry in low income countries have been developed. In the studies conducted with adults, it has been demonstrated that adequate correspondence can be established between the number of total lymphocytes and CD4+ cells with values of sensitivity and specificity sufficiently acceptable to recommend it as a substitute of the absolute count of CD4+ lymphocytes (5–7). Likewise, studies in the pediatric population recommend using the count of total lymphocytes as a substitute for CD4+ counts (8–9). On the other hand, different authors have focused in characterizing the variability of CD4+ cell counts in both seropositive and seronegative patients with the purpose of developing predictive models of said variability and its relationship with life expectancy in HIV positive populations in Zambia and South Africa. However, the objective of this study what’s not to establish a prediction of the value of CD4+ cells but to predict possible effects of having one of these in seropositive population (10). Besides, it is important to consider that the life expectancy is of this disease and its variation can be characterized under different factors such as region, quality of life and the type of population studied. in a subsequent study, these authors developed a model to predict the count of CD4+ cells from viral load With a performance of 87% (11).
Recent investigations have developed two types of predictive methodologies of the values of CD4+ lymphocytes from set and probability theories. In the first scenario, set theory was established for the analysis of its properties, that is, the study of objects clearly defined based on notions such as belonging as well as axioms that establish mathematical relations between them, allowing the development of operations like union or intersection. From these promises, through the method of sets, the value of leukocytes and total lymphocytes were taken to predict the value of CD4+ finding percentages of effectivity between 90% and 100% for leukocyte counts between 5000 and 4000 respectively (12). For the second case, with basis on probability theory, a prediction of the value of CD4 lymphocytes inferior to 570 CD4/µL from the counts of leukocytes and total lymphocytes inferior to 4000 with a probability equal to 1 (12). However, the predictions in intermediate ranges are not sufficiently high as to obtain clinical applications, which makes necessary a refinement of said methodology.
The purpose of this investigation is to develop a method to temporarily predict the population of CD4+ lymphocytes in HIV-infected patients in antiretroviral management from the absolute leukocyte count of blood count.