Diagnostic Value of Body Mass Index Total Lymphocyte Count, and Hemoglobin Level Combination to Predict Severe Immunodeficiency in Patients with Human Immunodeficiency Virus

Background: CD4+ lymphocyte count examination is not readily available, thus simple markers are required especially in regions with limited resources. This study aim was to determine diagnostic value of Body Mass Index (BMI), Total Lymphocyte Count (TLC), and hemoglobin level to predict severe immunodeficiency in HIV patients. Methods: Hospital-base consecutive sampling was used in recruiting HIV patients who met inclusion criteria. Receiver operator characteristic (ROC) method was used to determine cut-off of BMI and hemoglobin level in predicting severe immunodeficiency. Diagnostic accuracy of combination of BMI, TLC, and hemoglobin level was tested by stratified multivariate analysis to predict severe immunodeficiency. Results: One hundred and ten samples were included in this study. Cut-off point for BMI to predict severe immunodeficiency was <18.5 kg/m2, and for hemoglobin level was <12.2 gr/dl in male and <11.2 gr/dL in female. Using ROC diagnostic accuracy of BMI, TLC, and hemoglobin level combination was 90.3% (CI 95% 84.8-95.9%) with sensitivity 87.64% and specificity 71.42%; positive predicted value (PPV) 92.85%; negative predicted value (NVP) 57.69%; positive likelihood ratio (LH+) 3.07; and negative likelihood ratio (LH-) 0.17. Summary: Combination of BMI, TLC, and hemoglobin level is accurate and sensitive as a surrogate marker for CD4+ lymphocyte count in initiating ARV treatment in regions with limited resources where CD4+ lymphocyte count and viral load examinations are not readily available. Keywords: BMI, TLC, Hemoglobin Level, CD4+ Lymphocyte Count, Diagnostic Value