Clinical applications and availability of CD4+ T cell count testing in sub-Saharan Africa

Abstract Background The contribution of immune activation to arterial stiffness and its reversibility in human immunodeficiency virus (HIV)–infected adults in sub-Saharan Africa is unknown. Methods HIV-uninfected and HIV-infected Malawian adults initiating antiretroviral therapy (ART) with a CD4+ T-cell count of <100 cells/μL were enrolled and followed for 44 weeks; enrollment of infected adults occurred 2 weeks after ART initiation. We evaluated the relationship between carotid femoral pulse wave velocity (cfPWV) and T-cell activation (defined as HLA-DR+CD38+ T cells), exhaustion (define as PD-1+ T cells), and senescence (defined as CD57+ T cells) and monocyte subsets, using normal regression. Results In 279 HIV-infected and 110 HIV-uninfected adults, 142 (37%) had hypertension. HIV was independently associated with a 12% higher cfPWV (P = .02) at baseline and a 14% higher cfPWV at week 10 (P = .02), but the increases resolved by week 22. CD4+ and CD8+ T-cell exhaustion were independently associated with a higher cfPWV at baseline (P = .02). At 44 weeks, arterial stiffness improved more in those with greater decreases in the percentage of CD8+ T cells and the percentage of PD-1+CD8+ T cells (P = .01 and P = .03, respectively). When considering HIV-infected participants alone, the adjusted arterial stiffness at week 44 tended to be lower in those with higher baseline percentage of PD-1+CD8+ T cells (P = .054). Conclusions PD-1+CD8+ T-cells are associated with HIV-related arterial stiffness, which remains elevated during the first 3 months of ART. Resources to prevent cardiovascular disease in sub-Saharan Africa should focus on blood pressure reduction and individuals with a low CD4+ T-cell count during early ART.

Download Full-text

Timing of Antiretroviral Therapy and Systemic Inflammation in Sub-Saharan Africa: Results From the META Longitudinal Cohort Study

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz259 ◽

2019 ◽

Vol 220 (7) ◽

pp. 1172-1177 ◽

Cited By ~ 6

Author(s):

Mark J Siedner ◽

Mwebesa Bosco Bwana ◽

Stephen Asiimwe ◽

Gideon Amanyire ◽

Nicholas Musinguzi ◽

...

Keyword(s):

T Cell ◽

Antiretroviral Therapy ◽

Cell Count ◽

Late Stage ◽

Sub Saharan Africa ◽

Cd4 T Cell ◽

Disease Stage ◽

Stage Disease ◽

Late Stage Disease ◽

Cd4 T Cell Count

Abstract Chronic inflammation predicts complications in persons with human immunodeficiency virus infection. We compared D-dimer, soluble CD14, and interleukin 6 levels before and 12 months after antiretroviral therapy (ART) initiation, among individuals starting ART during earlier-stage (CD4 T-cell count >350/µL) or late-stage disease (CD4 T-cell count <200/µL). Female sex, older age, viral load, and late-stage disease were associated with pre-ART biomarkers (n = 661; P < .05). However, there were no differences in biomarkers by disease stage after 12 months of ART (n = 438; P > .05), owing to loss from observation and greater declines in biomarkers in late-stage initiators (P < .001). Earlier initiation of ART is associated with decreased inflammation, but levels seem to converge between earlier and later initiators surviving to 12 months.

Download Full-text

Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants

Clinical and Vaccine Immunology ◽

10.1128/cvi.00183-13 ◽

2013 ◽

Vol 20 (8) ◽

pp. 1123-1132 ◽

Cited By ~ 2

Author(s):

Christopher R. Sudfeld ◽

Christopher Duggan ◽

Alex Histed ◽

Karim P. Manji ◽

Simin N. Meydani ◽

...

Keyword(s):

T Cell ◽

Cell Count ◽

Sub Saharan Africa ◽

Cd4 T Cell ◽

Measles Vaccine ◽

Multivitamin Supplementation ◽

Hiv Exposed Infants ◽

Vaccine Responses ◽

Hiv Exposed ◽

Cd4 T Cell Count

ABSTRACTImmunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P> 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P= 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/μl than for infants whose mothers had a CD4 T-cell count of >350 cells/μl (P= 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P= 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P= 0.031). Maternal CD4 T-cell counts of <200 cells/μl were associated with decreased avidity compared to counts of >350 cells/μl (P= 0.047), as were lower infant height-for-age z-scores (P= 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered atClinicalTrials.govunder registration no. NCT00197730.)

Download Full-text

Trends in Kaposi sarcoma prevalence at HIV care initiation in adults at a large HIV treatment program in Jos, Nigeria

10.21203/rs.3.rs-22521/v1 ◽

2020 ◽

Author(s):

Maxwell O Akanbi ◽

Lucy. A. Bilaver ◽

Chad Achenbach ◽

Lisa. R. Hirschhorn ◽

Olugbenga A Silas ◽

...

Keyword(s):

T Cell ◽

Cell Count ◽

Kaposi Sarcoma ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

University Teaching ◽

Cd4 T Cell ◽

Hiv Care ◽

Cd4 T Cell Count ◽

Age And Sex

Abstract Background: Improved access to antiretroviral therapy (ART) significantly reduced the prevalence of Kaposi Sarcoma (KS) among patients initiating care for Human Immunodeficiency Virus (HIV) care in western nations. A similar pattern has not been universally documented across sub-Saharan Africa where the majority of people with HIV reside. This study examined trends in KS prevalence among adults initiating HIV care in Nigeria from 2006 to 2017.Methods: Data of patients 18 years or older, who initiated HIV care at the Jos University Teaching Hospital HIV clinic Jos, Nigeria from 2006 and 2017, were analyzed. Prevalence of KS over three consecutive four-year periods of increased ART coverage: 2006-2009, 2010-2013 and 2014-2017 were estimated. Logistic regression models were used to compare age- and sex-adjusted trends in KS prevalence rates at HIV care initiation over the three-time periods, and determine independent predictor of KS.Results: Among 16,431 adults who initiated HIV care from January 2006 to Decemeber 2017, mean age 35.1 (9.5) years, 65.7% female, and 51.1% with CD4 T-cell count < 200 cells/mm3; the overall prevalence of KS was 0.59 % (95% CI 0.48-0.72). KS prevalence was lowest at the time of HIV care initiation from 2006-2009 (0.39%; 95% CI 0.29-0.53), peaked at 1.12% (95% CI 0.82-1.52) from 2010-2013 and declined to 0.72% (95% CI 0.42-1.20) from 2014-2017. Compared to 2006-2009, age- and sex-adjusted odds for KS were 2.81 (95% CI 1.83-4.34, p<0.01) for 2010-2013 and 1.74 (95% CI 0.95-3.30, p=0.07) for 2014-2017. Independent predictors of KS were period of enrollment, male sex and low CD4 T-cell count. Conclusion: Expansion of ART access was not associated with a decline in KS prevalence among adults initiating ART in Nigeria.

Download Full-text

Intestinal Parasitic Infections in Relation to Diarrhea and CD4 T-cell Count among Saudi Patients with Chronic Renal Insufficiency

International Conference on Agricultural, Ecological and Medical Sciences (AEMS-2015) April 7-8, 2015 Phuket (Thailand) ◽

10.15242/iicbe.c0415042 ◽

2015 ◽

Keyword(s):

T Cell ◽

Renal Insufficiency ◽

Cell Count ◽

Chronic Renal Insufficiency ◽

Cd4 T Cell ◽

Parasitic Infections ◽

Intestinal Parasitic Infections ◽

Cd4 T Cell Count ◽

Saudi Patients

Download Full-text

Faculty Opinions recommendation of Relationship between T cell activation and CD4+ T cell count in HIV-seropositive individuals with undetectable plasma HIV RNA levels in the absence of therapy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1098360.554407 ◽

2007 ◽

Author(s):

William Shearer

Keyword(s):

T Cell ◽

Cell Count ◽

T Cell Activation ◽

Cell Activation ◽

Cd4 T Cell ◽

Hiv Rna ◽

Undetectable Plasma ◽

Hiv Seropositive ◽

Cd4 T Cell Count ◽

Rna Levels

Download Full-text

Faculty Opinions recommendation of CD4+ T cell count recovery in HIV type 1-infected patients is independent of class of antiretroviral therapy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1139018.596123 ◽

2008 ◽

Author(s):

Caroline Sabin

Keyword(s):

T Cell ◽

Antiretroviral Therapy ◽

Cell Count ◽

Cd4 T Cell ◽

Hiv Type 1 ◽

Cd4 T Cell Count ◽

Count Recovery

Download Full-text

The Effect of Antiretroviral Therapy on IL-6, IL-1β, TNF-α, IFN-γ Levels and their Relationship with HIV-RNA and CD4+ T Cells in HIV Patients

Current HIV Research ◽

10.2174/1570162x18666200712174642 ◽

2020 ◽

Vol 18 (5) ◽

pp. 354-361

Author(s):

Gülay Okay ◽

Meliha Meric Koc ◽

Eray Metin Guler ◽

Ayşegül Yabaci ◽

Abdürrahim Kocyigit ◽

...

Keyword(s):

T Cell ◽

Hiv Infection ◽

Cell Count ◽

Cd4 T Cell ◽

Positive Correlation ◽

Hiv Rna ◽

Tnf Α ◽

Cytokine Levels ◽

Ifn Γ ◽

Cd4 T Cell Count

Background: Serum cytokine levels over the course of HIV infection usually increase with immunosuppression and decrease after antiretroviral treatment (ART). Objectives: The aim of the study is to compare cytokine levels between HIV-infected patients (HIP) and controls and investigate the relationship between CD4+T cell count, HIV-RNA levels, and cytokine levels. Methods: The study subjects comprised ART-naive HIP (n=30) with no comorbidities and age-and sex-matched healthy controls. We measured levels of IL-6, IL-1β, TNF-α, and IFN-γ in serum samples of HIP at the beginning and at month 6 of ART and in controls. Results: The mean age of the study subjects was 38.7 ±10.3 years, with men making up 86.7% of the study subjects (n=26). IL-6, IL-1β, and TNF-α levels were significantly higher in both ART-naive (p<0.001, p=0.002, p=0.001) and ART-experienced HIP (p<0.001) than controls. The IFN-γ level was lower in both ART-naive and ART-experienced HIP compared to controls (p=0.082 and p=0.002). There was a positive correlation between the CD4+T cell count and serum concentration of IFN- γ(r=0.320, p<0.05). While the serum IFN-γ concentration showed a negative correlation with the HIVRNA level(r=-0.412, p<0.001), the serum IL-1β, IL-6, and TNF-α concentrations showed a positive correlation with the HIV-RNA level (r=0.349, p<0.001; r:0.54, p<0.001; r:0.438, p<0.00). Conclusions: Although serum concentrations of IL-6, IL-1β and TNF-α showed a significant decrease after ART, they were still significantly higher than the controls. IFN-γ responded differently to ART compared to the other cytokines, indicating that it may play a distinct and important role in the pathogenesis of HIV infection.

Download Full-text