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Reference Values of CD4-Lymphocyte Counts in HIV Seronegative Pregnant Women in Buea, Cameroon
RA Tanjong, J Atashili, HLF Kamga, G Ikomey, NT Akenji, MP Ndumbe
African Journal of Clinical and Experimental Microbiology , 2012,
Abstract: Pregnancy is a physiologically immunocompromised state, during which alterations in T-lymphocyte subsets may occur. Reference values for CD4 counts in pregnancy have not been established particularly in sub-Saharan populations. This study aimed at describing expected (‘normal’) values of CD4 counts in healthy HIV-negative pregnant women so these could serve as reference for assessing the progress of HIV disease in HIV-infected pregnant women. The study was conducted in antenatal clinics in the Buea Health District, Cameroon. All eligible women were interviewed using a standardized questionnaire. Whole blood samples collected were tested for HIV using Determine 1/2 and SD Bioline HIV-1/2 3.0 rapid tests. The CD4+ absolute counts were assessed using the Partec Cyflow Counter and the CD4 easy count kit. A total of 279 women were analysed. Their ages ranged from 15 to 47 years. A vast majority (95%) of participants were in the second or third trimester of gestation. Slightly less than half (43%) were primiparous. The CD4 cell count ranged from 321 to 1808 cells/μl . This distribution was approximately normal with a mean of 851cells/μl, a median of 831cells/μl , and a standard deviation of 254cells/μl . The expected (‘normal’) range, covering 95% of the sample was 438-1532 cells/μl. Participants with malaria parasitaemia tended to have a lower CD4 count (lower on average by 115 cells/μl, P<0.001). CD4 cell counts in HIV-negative pregnant women appear similar to those of the general population of HIV-negatives. These values can thus be used as references when assessing HIV-seropositive pregnant women.
Factors Associated with Self-Reported Repeat HIV Testing after a Negative Result in Durban, South Africa  [PDF]
Susan Regan, Elena Losina, Senica Chetty, Janet Giddy, Rochelle P. Walensky, Douglas Ross, Helga Holst, Jeffrey N. Katz, Kenneth A. Freedberg, Ingrid V. Bassett
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0062362
Abstract: Background Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country. Methods We analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR’s) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model. Results Of 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p<0.001). Median CD4 count was higher among repeat than first-time testers (201/uL vs. 147/uL, p<0.001). Among those HIV negative at enrollment (N = 2,499), repeat testing was more common among those with family or friends living with HIV (ARR 1.50, 95% CI: 1.33–1.68), women (ARR: 1.24, 95% CI: 1.11–1.40), and those self-reporting very good health (ARR: 1.28, 95% CI: 1.12–1.45). Conclusions In this high prevalence setting, repeat testing was common among those undergoing HIV screening, and was associated with female sex, lower prevalence of HIV infection, and higher CD4 counts at diagnosis.
Population-Based CD4 Counts in a Rural Area in South Africa with High HIV Prevalence and High Antiretroviral Treatment Coverage  [PDF]
Abraham Malaza, Jo?l Mossong, Till B?rnighausen, Johannes Viljoen, Marie-Louise Newell
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0070126
Abstract: Background Little is known about the variability of CD4 counts in the general population of sub-Saharan Africa countries affected by the HIV epidemic. We investigated factors associated with CD4 counts in a rural area in South Africa with high HIV prevalence and high antiretroviral treatment (ART) coverage. Methods CD4 counts, health status, body mass index (BMI), demographic characteristics and HIV status were assessed in 4990 adult resident participants of a demographic surveillance in rural KwaZulu-Natal in South Africa; antiretroviral treatment duration was obtained from a linked clinical database. Multivariable regression analysis, overall and stratified by HIV status, was performed with CD4 count levels as outcome. Results Median CD4 counts were significantly higher in women than in men overall (714 vs. 630 cells/μl, p<0.0001), both in HIV-uninfected (833 vs. 683 cells/μl, p<0.0001) and HIV-infected adults (384.5 vs. 333 cells/μl, p<0.0001). In multivariable regression analysis, women had 19.4% (95% confidence interval (CI) 16.1–22.9) higher CD4 counts than men, controlling for age, HIV status, urban/rural residence, household wealth, education, BMI, self-reported tuberculosis, high blood pressure, other chronic illnesses and sample processing delay. At ART initiation, HIV-infected adults had 21.7% (95% CI 14.6–28.2) lower CD4 counts than treatment-naive individuals; CD4 counts were estimated to increase by 9.2% (95% CI 6.2–12.4) per year of treatment. Conclusions CD4 counts are primarily determined by sex in HIV-uninfected adults, and by sex, age and duration of antiretroviral treatment in HIV-infected adults. Lower CD4 counts at ART initiation in men could be a consequence of lower CD4 cell counts before HIV acquisition.
CD4 Counts and Viral Loads of Newly Diagnosed HIV-Infected Individuals: Implications for Treatment as Prevention  [PDF]
Sarishen Govender, Kennedy Otwombe, Thandekile Essien, Ravindre Panchia, Guy de Bruyn, Lerato Mohapi, Glenda Gray, Neil Martinson
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090754
Abstract: Objective To report the viral load and CD4 count in HIV-infected, antiretroviral na?ve, first -time HIV-testers, not immediately eligible for treatment initiation by current South Africa treatment guidelines. Design This was a cross-sectional study in a high-volume, free-of-charge HIV testing centre in Soweto, South Africa. Methods We enrolled first time HIV testers and collected demographic and risk-behaviour data and measured CD4 count and viral load. Results Between March and October 2011, a total of 4793 adults attended VCT and 1062 (22%) tested positive. Of the 1062, 799 (75%) were ART na?ve and 348/799 (44%) were first-time HIV testers. Of this group of 348, 225 (65%) were female. Overall their median age, CD4 count and viral load was 34 years (IQR: 28-41), 364 (IQR: 238-542) cells/mm3 and 13,000 (IQR: 2050-98171) copies/ml, respectively. Female first time HIV testers had higher CD4 counts (419 IQR: 262-582 vs. 303 IQR: 199-418 cells/mm3) and lower viral loads (9,100 vs. 34,000 copies/ml) compared to males. Of 183 participants with CD4 count >350 cells/mm3, 62 (34%) had viral loads > 10,000 copies/ml. Conclusions A large proportion of HIV infected adults not qualifying for immediate ART at the CD4 count threshold of 350 cells/mm3 have high viral loads. HIV-infected men at their first HIV diagnosis are more likely to have lower CD4 counts and higher viral loads than women.
HIV Patients Developing Primary CNS Lymphoma Lack EBV-Specific CD4+ T Cell Function Irrespective of Absolute CD4+ T Cell Counts  [PDF]
Olivier Gasser,Florian K Bihl,Marcel Wolbers,Elisabetta Loggi,Ingrid Steffen,Hans H Hirsch,Huldrych F Günthard,Bruce D Walker,Christian Brander,Manuel Battegay,Christoph Hess ,for the Swiss HIV Cohort Study
PLOS Medicine , 2007, DOI: 10.1371/journal.pmed.0040096
Abstract: Background In chronic HIV infection, antiretroviral therapy–induced normalization of CD4+ T cell counts (immune reconstitution [IR]) is associated with a decreased incidence of opportunistic diseases. However, some individuals remain at risk for opportunistic diseases despite prolonged normalization of CD4+ T cell counts. Deficient Epstein-Barr virus (EBV)-specific CD4+ T cell function may explain the occurrence of EBV-associated opportunistic malignancy—such as primary central nervous system (PCNS) lymphoma—despite recovery of absolute CD4+ T cell counts. Methods and Findings Absolute CD4+ T cell counts and EBV-specific CD4+ T cell-dependent interferon-γ production were assessed in six HIV-positive individuals prior to development of PCNS lymphoma (“cases”), and these values were compared with those in 16 HIV-infected matched participants with no sign of EBV-associated pathology (“matched controls”) and 11 nonmatched HIV-negative blood donors. Half of the PCNS lymphoma patients fulfilled IR criteria (defined here as CD4+ T cell counts ≥500/μl blood). EBV-specific CD4+ T cells were assessed 0.5–4.7 y prior to diagnosis of lymphoma. In 0/6 cases versus 13/16 matched controls an EBV-specific CD4+ T cell response was detected (p = 0.007; confidence interval for odds ratio [0–0.40]). PCNS lymphoma patients also differed with regards to this response significantly from HIV-negative blood donors (p < 0.001, confidence interval for odds ratio [0–0.14]), but there was no evidence for a difference between HIV-negative participants and the HIV-positive matched controls (p = 0.47). Conclusions Irrespective of absolute CD4+ T cell counts, HIV-positive patients who subsequently developed PCNS lymphoma lacked EBV-specific CD4+ T cell function. Larger, ideally prospective studies are needed to confirm these preliminary data, and clarify the impact of pathogen-specific versus surrogate marker-based assessment of IR on clinical outcome.
Associations Between CD4 Cell Counts and Clinical Presentations Among HIV/AIDS Patients in Cameroon  [PDF]
G. Alemnji,J. Mbuagbaw,G. Afetane,M. Nkam
Journal of Medical Sciences , 2006,
Abstract: The present study was aimed at establishing relationships between CD4 cell counts and various clinical presentations commonly associated with HIV/AIDS patients in Cameroon. This study was made up of retrospective and prospective phases, carried out among HIV positive cases seen at the Internal Medicine Service of the University of Yaounde Teaching Hospital. After informed consent, data was collected from participants. This included information on demographic and various clinical signs and symptoms associated with HIV/AIDS as well as CD4 cell count results. The population studied consisted of 556 positive cases, 58% females (323) and 42% males (233). HIV positive status were known among 89.9% of the cases following episodes of ill health while Voluntary Counselling and Testing (VCT) diagnosed HIV only among 5% of them. Cases were grouped into clinical categories as follows: A 14.5%, B 33.2%, C 28.2% and 24.1% were not classified. Clinical signs and symptoms were dominated by anaemia 61%, pneumonia 34.5%, meningitis 9.9%, unexplained fiver 34.4%, loss of weight more than 10%, 30.4%, tiredness 21.2 %, diarrhoea 14.2% and cough 11.1%. In all, 29.6% of the subjects had CD4 cell counts less than 100 cell mm-3, while 43.3% of them had counts below 200 cells mm-3. Statistically significant associations were established between low CD4 cell counts and various pathologies as follows: tuberculosis p<0.01, oral candidosis p<0.02, kaposi`s sarcoma p<0.04, herpes zoster p<0.002 and genital herpes p<0.05. The present study shows that majority of the subjects get to know their HIV status very late, already developing clinical signs and symptoms of AIDS with very low CD4 cell counts. There is need for improvement of early HIV diagnosis strategy through education and voluntary counselling among populations in Africa.
Risk Factors for Late-Stage HIV Disease Presentation at Initial HIV Diagnosis in Durban, South Africa  [PDF]
Paul K. Drain, Elena Losina, Gary Parker, Janet Giddy, Douglas Ross, Jeffrey N. Katz, Sharon M. Coleman, Laura M. Bogart, Kenneth A. Freedberg, Rochelle P. Walensky, Ingrid V. Bassett
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0055305
Abstract: Background After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults. Methods We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm3. We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing (“competing needs to healthcare”) on presentation with late-stage HIV disease. Results Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% CI 1.7–4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2–2.4), were male (AOR 1.7, 95% CI 1.2–2.3), worked outside the home (AOR 1.5, 95% CI 1.1–2.1), perceived health service delivery barriers (AOR 1.5, 95% CI 1.1–2.1), and/or had poor emotional health (AOR 1.4, 95% CI 1.0–1.9) had higher odds of late-stage HIV disease presentation. Conclusions Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease.
Attitudes of People in the UK with HIV Who Are Antiretroviral (ART) Na?ve to Starting ART at High CD4 Counts for Potential Health Benefit or to Prevent HIV Transmission  [PDF]
Alison J. Rodger, Andrew Phillips, Andrew Speakman, Richard Gilson, Martin Fisher, Ed Wilkins, Jane Anderson, Margaret Johnson, Rebecca O'Connell, Simon Collins, Jonathan Elford, Lorraine Sherr, Fiona C. Lampe, for the ASTRA (Antiretrovirals, Sexual Transmission Risk and Attitudes) Study Group
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0097340
Abstract: Objective To assess if a strategy of early ART to prevent HIV transmission is acceptable to ART na?ve people with HIV with high CD4 counts. Design ASTRA is a UK multicentre, cross sectional study of 3258 HIV outpatients in 2011/12. A self-completed questionnaire collected sociodemographic, behavioral and health data, and attitudes to ART; CD4 count was recorded from clinical records. Methods ART na?ve participants with CD4 ≥350 cells/μL (n = 281) were asked to agree/disagree/undecided with the statements (i) I would want to start treatment now if this would slightly reduce my risk of getting a serious illness, and (ii) I would want to start treatment now if this would make me less infectious to a sexual partner, even if there was no benefit to my own health. Results Participants were 85% MSM, 76% white, 11% women. Of 281 participants, 49.5% and 45.2% agreed they would start ART for reasons (i) and (ii) respectively; 62.6% agreed with either (i) or (ii); 12.5% agreed with neither; 24.9% were uncertain. Factors independently associated (p<0.1) with agreement to (i) were: lower CD4, more recent HIV diagnosis, physical symptoms, not being depressed, greater financial hardship, and with agreement to (ii) were: being heterosexual, more recent HIV diagnosis, being sexually active. Conclusions A strategy of starting ART at high CD4 counts is likely to be acceptable to the majority of HIV-diagnosed individuals. Almost half with CD4 >350 would start ART to reduce infectiousness, even if treatment did not benefit their own health. However a significant minority would not like to start ART either for modest health benefit or to reduce infectivity. Any change in approach to ART initiation must take account of individual preferences. Transmission models of potential benefit of early ART should consider that ART uptake may be lower than that seen with low CD4 counts.
Correlation of CD4 Counts with Renal Disease in HIV Positive Patients  [cached]
Janakiraman Hari,Abraham Georgi,Matthew Milly,Kuruvilla Sarah
Saudi Journal of Kidney Diseases and Transplantation , 2008,
Abstract: To correlate CD 4 counts with albuminuria and glomerular lesions in patients infected with human immunodeficiency virus (HIV), we studied 104 HIV positive patients (68 males, 36 females) of whom 100 patients were infected by heterosexual contact, 3 by transfusion, and 1 by IV drug abuse. We screened over nine months for albuminuria by urine dip stick method, and performed renal biopsy on patients with albuminuria 2+ or more. Histological examination was accomplished by light microscopy in all and by electron microscopy when it was feasible. Albuminuria was observed in 29 (27%) patients, and it revealed a significant negative correlation with CD4 count (p < 0.01). Patients with CD4 cells < 350 cells/mm [3] disclosed a 3.5 fold increased risk of albuminuria as compared with patients with CD4 > 350 cells/mm [3] . There was no significant correlation between proteinuria and the duration of infection from the time of diagnosis. Albuminuria also demonstrated a significant negative correlation with the levels of hemoglobin (p< 0.05). In addition, low numbers of CD4 cells were associated with lower levels of hemoglobin (p< 0.001). Only 10 patients received renal biopsies, and the results revealed HIV-associated nephro-pathy (HIVAN) in 7 (70%) patients, chronic tubulointerstitial nephritis in 1, membranous glome-rulopathy in 1, and diffuse proliferative glomerulonephritis in 1. Acute renal failure was present in 5 patients, of whom four had a pre renal component and one had multiorgan dysfunction syndrome. We conclude that our study demonstrates that both proteinuria and HIVAN are common in HIV infected patients. Proteinuria has a negative correlation with the CD4 counts and hemoglobin levels.
Prevalência da co-infec??o HIV-sífilis em um hospital universitário da cidade do Rio de Janeiro no ano de 2005
Signorini, Dario José Hart Pontes;Monteiro, Michelle Carreira Miranda;Sá, Carlos Alberto Morais de;Sion, Fernando Samuel;Leit?o Neto, Hilton Gueiros;Lima, Dulcino Pirovani;Machado, Jo?o Dario do Carmo;
Revista da Sociedade Brasileira de Medicina Tropical , 2007, DOI: 10.1590/S0037-86822007000300006
Abstract: this was a study on the prevalence of hiv-syphilis coinfection among 830 hiv/aids patients who were being followed up as outpatients at a hospital in rio de janeiro between january and may 2005. the participants underwent laboratory tests at the venereal disease research laboratory (vdrl) consisting of cd4+/cd8+ cell counts and viral load tests. they answered questions about their sociodemographic characteristics and past medical history of syphilis. the prevalence of syphilis was 2.7% (22 patients) and the ratio between men and women with coinfection was approximately 4:1. homosexual men were the category most affected. we did not find any association between coinfection and age, schooling and the laboratory parameters tested. out of the total number of patients with syphilis, 73% (16) reported previous treatment; of these, 14 (88%) were reinfected, while two (12%) underwent inappropriate treatment. the presence of hiv-syphilis coinfection among patients undergoing routine follow-up signals the need to advise them to adopt safe sex practices, during their outpatient visits.
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