Skip to main content Skip to main navigation menu Skip to site footer

Correlation between T-lymphocyte CD4+ and Total Lymphocyte Count (TLC), hemoglobin, Neutrophil to Lymphocyte Ratio (NLR) and T-lymphocyte CD4+/CD8+ ratio in HIV patients at Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia

  • Made Ayu Vita Prianggandanni ,
  • Anak Agung Wiradewi Lestari ,
  • I Nyoman Wande ,
  • Ni Nyoman Mahartini ,
  • Sianny Herawati ,


Background: Human Immunodeficiency Virus (HIV) is an RNA virus from the Retroviridae family, Lentiviri subfamily, which attacks the immune system, especially T lymphocytes, namely Cluster of Differentiation 4+ (CD4+) cells. Human Immunodeficiency Virus destroys T lymphocyte CD4+ cells, decreasing immunity against opportunistic infections. For monitoring of HIV, an examination of T lymphocyte CD4+ cells and complete blood counts were conducted.

Methods: A cross-sectional quantitative analytic study was conducted from October 2021 to January 2022 at Prof. Dr. IGNG Ngoerah Hospital. Measurements were made on the total number of lymphocytes, hemoglobin levels, neutrophil-to-lymphocyte ratio (NLR), CD4+ levels and CD4+/CD8+ ratios. We analyze normality data using Kolmogorov-Smirnov and correlation using Pearson and Spearman tests. The p-value < 0.05 was considered significant.

Results: 56 patients met the inclusion and exclusion criteria, with 46 males (82.1%) and 10 females (17.9%). Mean age 38.98±11.58 years, mean total lymphocyte 0.64 x 103 μL, median T lymphocyte CD4+ 133.50 sel/mm3, mean hemoglobin 10.11±1.49 g/dL, median NLR 6.51, median CD4+/CD8+ ratio 0.06. The hemoglobin variable was normally distributed, while the other variables were abnormal. The Pearson Correlation test showed a significant relationship between T lymphocytes CD4+ and hemoglobin with r=0.329 (p=0.013). Spearman's Correlation test showed a significant relationship between T lymphocytes CD4+ and NLR, total lymphocytes, CD4+/CD8+ ratio with r-0.334 (p=0.012), r=0.777 (p=0.000), r=0.729 (p=0.000) respectively.

Conclusion: There is a strong and significant correlation between the level of T lymphocytes CD4+ and total lymphocyte count and the ratio of CD4+/CD8+, a weak and significant correlation between the level of T lymphocytes CD4+ with hemoglobin and NLR in HIV patients at Prof. Dr. IGNG Ngoerah Hospital.


  1. Simonetti FR, Dewar R, Maldarelli F. Diagnosis of Human Immunodeficiency Virus Infection. Eighth Edi, Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Eighth Ed. Elsevier Inc. 2017.
  2. Kemenkes RI. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/90/2019 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana HIV. Kementerian Kesehatan Republik Indonesia. 2019.
  3. Sadarang RAI. Prevalence and Factors Affecting Discrimination Towards People Living With HIV/AIDS in Indonesia. J Prev Med Public Health. 2022;55(2):205-212.
  4. Agwu A. Sexuality, Sexual Health, and Sexually Transmitted Infections in Adolescents and Young Adults. Top Antivir Med. 2020;28(2):459-462.
  5. Sabin CA, Lundgren JD. The natural history of HIV infection. Curr Opin HIV AIDS. 2013;8(4):311-317.
  6. Langford SE, Ananworanich J, Cooper DA. Predictors of disease progression in HIV infections: a review. AIDS Research and Therapy. 2007;4(1):11-25.
  7. Kementerian Kesehatan Republin Indonesia (Kemenkes RI). Program Pengendalian HIV/AIDS dan PIMS Fasilitas Kesehatan Tingkat Pertama. Kementerian Kesehatan RI. 2017:613–614.
  8. Burchett SK, Pizzo PA. HIV Infection in Infants, children, and Adolescents. Pediatr Rev. 2013;24(1):186–194.
  9. Githinji N, Maleche-Obimbo E, Nderitu M, Wamalwa DC, Mbori- Ngacha D. Utility of total lymphocyte count as a surrogate marker for CD4 counts in HIV-1 infected in Kenya. BMC Infect Dis. 2011;11(1):1-8.
  10. Stebbing J, Sawleshwarkar S, Michailidis C, Jones R, Bower M, Mandalia S. Assessment of the efficacy of total lymphocyte counts as predictors of AIDS defining infections in HIV-1 infected people. Postgrad Med J. 2005;81(959):586–588.
  11. Mwamburi DM, Ghosh M, Fauntleroy J, Gorbach SL, Wanke CA. Predicting CD4 count using total lymphocyte count: A sustainable tool for clinical decisions during HAART use. Am J Trop Med Hyg. 2015;73(1):58–62.
  12. Ageru TA, Koyra MM, Gidebo KD, Abiso TL. Anemia and its associated factors among adult people living with human immunodeficiency virus at Wolaita Sodo University teaching referral hospital. PLoS One. 2019;14(10):e0221853.
  13. Fransiska Y, Kurniawaty E. Anemia pada Infeksi HIV. Jurnal Majority. 2015;4(9):123128.
  14. Wipasa J, Wongkulab P, Chawansuntati K, Chaiwarit R. Cellular immune responses in HIV-negative immunodeficiency with anti-interferon gamma antibodies and opportunistic intracellular microorganisms. Plos one. 2010;9(1):2- 3.
  15. Marin JM, Martinez JE, Martinez RE, Anduisza CA. Risk factors and correlates for anemia in HIV treatment-naïve infected patients: a cross sectional analytical study. BMC Res Notes. 2010;3(1):230-232
  16. Tudela EV, Singh MK, Lagman M, Ly J, Patel N, Ochoa C. Cytokine levels in plasma samples of individuals with HIV infection. Austin J Clin Immunol. 2012;1(1):2-4.
  17. Liew PX, Kubes P. The neutrophil's role during health and disease. Physiol Rev. 2019;99(1):1223–1248.
  18. Emokpae MA, Aruomaren AI, Mrakpor BA. Association of Neutrophil- to-lymphocyte ratio with Respiratory burst enzymes in Human Immunodeficiency virus type 1 infected Africans. J Med Discov. 2016;2(2):17025.
  19. Wiranata S, Anjani IAW, Saputra IPGS, Sadvika IGAS, Prabawa IPY, Supadmanaba IG. Pretreatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as a stage determination in breast cancer. Open Access Macedonian Journal of Medical Sciences. 2020:8(B):1058-1063.
  20. Yustin WEF, Somia IKA, Arisanti NLPE, Artana IGNBN, Kusumawardani IAJD, Candrawati NW. Association between clinical parameters, laboratorium and radiology along with validation of scoring system with lung tuberculosis status in adult HIV patients. Bali Medical Journal. 2021;10(3):1085–1092.
  21. Saracinoa A, Brunoa B, Scudeller L, Ladisaa L, Allegrini M. CD4 and CD4/CD8 ratio progression in HIV-HCV infected patients after achievement of SVR. Journal of Clinical Virology. 2016;81(1):94–99.
  22. Wande IN, Fuadi MR, Hadi S. The Correlation between total lymphocyte count, hemoglobin levels, lymphocyte/leukocyte ratio (LLR), and lymphocyte/neutrophil ratio (LNR) to CD4 levels in patients with Human Immunodeficiency Virus infection at Sanglah Hospital. Bali Medical Journal. 2019;8(2):429–433.
  23. Mendez TD, Napravnik S, Zakharova O, Kuruc J, Gay C. Acute HIV Infection and CD4/CD8 Ratio Normalization After Antiretroviral Therapy Initiation. J Acquir Immune Defic Syndr. 2018;79(1):510–518.
  24. Harningtyas CD, Damayanti, Sari M, Listiawan MY, Indramaya DM, Astari L. Relationship between CD4 levels and mucocutaneous manifestations in HIV-AIDS patients at Dr. Soetomo General Academic Teaching Hospital, Surabaya, Indonesia. Bali Medical Journal. 2022;11(1):216–222.

How to Cite

Prianggandanni, M. A. V., Lestari, A. A. W., Wande, I. N., Mahartini, N. N., & Herawati, S. (2023). Correlation between T-lymphocyte CD4+ and Total Lymphocyte Count (TLC), hemoglobin, Neutrophil to Lymphocyte Ratio (NLR) and T-lymphocyte CD4+/CD8+ ratio in HIV patients at Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia. Bali Medical Journal, 12(2), 2017–2021.




Search Panel

Made Ayu Vita Prianggandanni
Google Scholar
BMJ Journal

Anak Agung Wiradewi Lestari
Google Scholar
BMJ Journal

I Nyoman Wande
Google Scholar
BMJ Journal

Ni Nyoman Mahartini
Google Scholar
BMJ Journal

Sianny Herawati
Google Scholar
BMJ Journal