Prediction of survival and opportunistic infections in HIV-infected patients: a comparison of imputation methods of incomplete CD4 counts

2002 ◽  
Vol 21 (10) ◽  
pp. 1387-1408 ◽  
Author(s):  
Geert Molenberghs ◽  
Paige L. Williams ◽  
Stuart R. Lipsitz
Keyword(s):  
Opportunistic Infections ◽  
Cd4 Counts ◽  
Imputation Methods ◽  
Prediction Of Survival

scholarly journals Hematological abnormalities in HIV infected individuals in correlation to CD4 counts and ART status

2016 ◽  
Vol 7 (4) ◽  
pp. 14-18 ◽  
Author(s):  
R Raman Thulasi ◽  
D Manimaran ◽  
G Hemanathan ◽  
Tameem Afroz ◽  
Radha Sagar
Keyword(s):  
Opportunistic Infections ◽  
Hematological Parameters ◽  
Cd4 Count ◽  
Health Concern ◽  
Medical Sciences ◽  
Cd4 Counts ◽  
Medical Centers ◽  
Hematological Abnormalities ◽  
Set Up ◽  
One Year

Background: HIV is pandemic and remains as a public health concern for many decades. This infection though associated with many opportunistic infections and neoplasms, it is further complicated with marked hematological abnormalities. The aim of this study is to determine the magnitude & severity of hematological abnormalities in HIV infected individuals and also to analyze these abnormalities in correlation with the CD4 counts. We also compared these hematological abnormalities in patients on ART and those not on ART.Materials and Methods: The study was conducted for a period of one year, on 120 HIV positive cases including both patients on ART & not on ART. Controls with similar age and sex distribution was set up. The blood samples were collected and processed in an automated cell counter. The parameters were tabulated and analyzed with respect to CD4 count & ART status.Results: Among the total of 120 HIV cases, 77% had anemia, 21% had leucopenia and 5% had thrombocytopenia. The magnitude and severity of anemia, leucopenia, thrombocytopenia and other parameters was found to be more in patients not on ART, when compared to patients on ART. Similarly, the magnitude and severity of most of hematological abnormalities were inversely proportional to the CD4 count in non-ART cases but not with cases on ART.Conclusion: The basic hematological parameters can be used as a prospective screening test to assess the severity and progression of HIV infection when CD4 count is not available. These parameters can also be used to assess the response to anti-retroviral treatment. Therefore, these basic hematological investigations readily available at all medical centers are of great use while treating HIV infected patients.Asian Journal of Medical Sciences Vol.7(4) 2016 14-18 

scholarly journals A study of clinical spectrum of opportunistic infections in HIV infected children and its correlation with CD4 count and anti-retroviral therapy

2017 ◽  
Vol 4 (4) ◽  
pp. 1485
Author(s):  
Vishal Manohar Jadhav ◽  
Yashwant Raghu Gabhale ◽  
Mamatha Murad Lala ◽  
Nikita Dilip Shah ◽  
Mamta Vijay Manglani
Keyword(s):  
Opportunistic Infections ◽  
Molluscum Contagiosum ◽  
Cd4 Count ◽  
Clinical Spectrum ◽  
Pneumocystis Jiroveci ◽  
Female Ratio ◽  
Cd4 Counts ◽  
Pneumocystis Jiroveci Pneumonia ◽  
High Index Of Suspicion ◽  
Male To Female

Background: To determine the clinical spectrum and prevalence of opportunistic infections (OIs) in HIV infected children and correlate the occurrence of opportunistic infections with their CD4 count and Anti-retroviral treatment (ART).Methods: A total of 100 HIV infected children diagnosed with opportunistic infections were included in the study. Demographic details, clinical examination and relevant investigations were done for all the children. Clinical spectrum of OIs and HIV staging was recorded. CD4 counts were done at baseline and were repeated at 6 monthly intervals.Results: Mean age of the patients was 7.08±3.48 years (ranging from 6 months to 15 years) at enrollment with male to female ratio of 1.2:1. Fever (91%) was a common presenting symptom followed by weight loss (74%), cough (37%), abdominal pain (29%) and breathlessness (16%). CD4 count was significantly associated with presence of opportunistic infection in the study group. Tuberculosis - pulmonary (32%) and extra-pulmonary (29%) was the most common oppurtunistic infections, followed by oral thrush (13%), Herpes zoster (10%), Molluscum Contagiosum (9%), Pneumocystis jiroveci pneumonia (3%), Parvovirus infection (3%) and Pruritic Papular Eruptions (2%). 70% children were on ART as per clinical and immunological staging of HIV.Conclusions: Low CD4 count is significantly associated with severe opportunistic infections, therefore drop in CD4 count should serve as an alarming signal for the treating physician. High index of suspicion is required to detect opportunistic infections and therefore CD4 counts should be done more frequently to predict occurrence of OIs. 

A proposal for basic management of HIV disease in West Africa: use of clinical staging and haemogram data

1998 ◽  
Vol 9 (8) ◽  
pp. 463-470 ◽  
Author(s):  
E Ledru ◽  
S Diagbouga ◽  
N Meda ◽  
P T Sanou ◽  
H Dahourou ◽  
...  
Keyword(s):  
Lymphocyte Count ◽  
Opportunistic Infections ◽  
Clinical Stage ◽  
Cross Sectional Study ◽  
Clinical Staging ◽  
Chronic Diarrhoea ◽  
Hiv Disease ◽  
Cross Sectional ◽  
Cd4 Counts ◽  
African People

Summary: Our objective was to propose a strategy to screen HIV infected African people for biological immunodeficiency easily. In a cross sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV infected adults. Peripheral facial paralysis and chronic cutaneo mucous diseases were the earlier B stage diseases. Pulmonary tuberculosis was close to B stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C stage symptom 47.8 . Ninety per cent of CDC C stage people had CD4 counts below 350 mul, whereas only 75 had CD4 counts below 200 mul. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350 mul. A simple score lymphocyte count 2500 mul and clinical stage B is proposed to determine this CD4 threshold positive predictive value: 83 and to determine those patients needing treatment to prevent wasting and opportunistic infections.

scholarly journals Prevalence of opportunistic infections in HIV-positive patients in Bahrain: a four-year review (2009-2013)

2015 ◽  
Vol 9 (01) ◽  
pp. 060-069 ◽  
Author(s):  
Nermin Kamal Saeed ◽  
Eman Farid ◽  
Afaf E Jamsheer
Keyword(s):  
Bacterial Infections ◽  
Opportunistic Infections ◽  
Arab World ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cd4 Counts ◽  
Significant Difference ◽  
Streptococcus Milleri ◽  
Mycobacteria Other Than Tuberculosis

Introduction: This study aimed to examine the prevalence of opportunistic infections in HIV-infected patients in Bahrain and its relation to absolute CD4 count, CD4%, and CD4/CD8 ratio. Methodology: This retrospective cohort study used laboratory records (January 2009 - May 2013) from a major hospital in Bahrain. Opportunistic infections (OIs); absolute CD4 counts, CD4%, and CD4/CD8 ratio were recorded. Results: CD4% and absolute CD4 count in HIV patients with associated infections (157 ± 295) was significantly lower than in those without associated infections (471 ± 285) (p < 0.001). There was no significant difference in CD4/CD8 ratio between the two groups. Infection with Staphylococcus aureus was the commonest infection, present in 9.8% of total HIV-infected patients and 28.7% of members of the AIDS patient group with OIs, followed by yeast infections (9.2% and 27.2%, respectively). Mycobacterium tuberculosis was present in 3.6% of total HIV-infected patients and 10.6% of the group with OIs, while mycobacteria other than tuberculosis (MOTT) was present in 2.5% and 7.5%, respectively. Pneumocystis jirovecii pneumonia (PCP) was observed in 5.1% and 15.1%, respectively. Herpes simplex II (HSV-II) was observed in 3% and 9%, respectively, while Cytomegalovirus antigenemia was only present in 2% and 6%, respectively. Streptococcus pneumoniae, Streptococcus milleri, Stenotrophomonas maltophilia, and Citrobacter species were bacterial infections observed least frequently. Conclusions: Studying the pattern of OIs in HIV-infected patients in Bahrain is of paramount importance due to the scarcity of data in the Arab world. This will help to improve physicians’ awareness to improve care of HIV-infected patients.

scholarly journals The Association of CD4, CD8, and CD4/CD8 Ratio with Thyroid Dysfunction in HIV/AIDS

2021 ◽  
Vol 27 (3) ◽  
pp. 326
Author(s):  
Sri Mulyani ◽  
MI. Diah Pramudianti ◽  
Dian Ariningrum
Keyword(s):  
Viral Load ◽  
Thyroid Dysfunction ◽  
Opportunistic Infections ◽  
Prevalence Ratio ◽  
Aids Patients ◽  
Cross Sectional ◽  
Cd4 Counts ◽  
Hiv Rna ◽  
Cross Sectional Design ◽  
Hiv Aids

Incidence of thyroid dysfunction increases in HIV/AIDS patients. It can be a hypothyroid or hyperthyroid, with subclinical hypothyroid predomination. Thyroid dysfunction is associated with the progression of HIV and low CD4 counts. There has been controversy over how HIV affects thyroid function. Opportunistic infections and HBV/HCV co-infections might increase the probability of thyroid dysfunction. Medication of HIV is also an important factor of thyroid dysfunction. Research shows that the use of ART increases the probability of thyroid dysfunction. This study aimed to analyze the association between CD4 counts, CD8, CD4/CD8 ratio, and HIV RNA viral load with thyroid dysfunction in HIV/AIDS patients. An observational study with a cross-sectional design was conducted from August to September 2020 in Dr. Moewardi Hospital, Surakarta on 60 HIV/AIDS patients. All subjects were 18-60 years old. The research data were analyzed with a 2x2 test table to determine the Prevalence Ratio (PR) of each variable, then multivariate analysis with logistic regression was continued. The study showed 6.7% thyroid dysfunction in HIV/AIDS patients, 5% subclinical hyperthyroidism, and 1.7% subclinical hypothyroidism. The CD4 counts [PR 13.36 (95% CI: 1.53-116,65; p=0.017) and CD8 counts [PR 0.91 (95% CI: 3 0.02-0.51; p=0.032)] significantly associated with thyroid dysfunction in HIV/AIDS patients. CD4 counts < 200 cells/mm and 3 CD8 counts ≥500 cells/mm were associated with the incidence of thyroid dysfunction in HIV/AIDS patients, while CD4/CD8 ratio and HIV RNA viral load were not associated. CD4 count was not an independent predictor of thyroid dysfunction in HIV/AIDS patients.

scholarly journals Spectrum of opportunistic infections with correlation to CD4 counts in newly diagnosed HIV seropositive cases

2017 ◽  
Vol 4 (1) ◽  
pp. 252
Author(s):  
Ajay Kumar Sarvepalli ◽  
Prakash Kalakappa Dharana
Keyword(s):  
Opportunistic Infections ◽  
Newly Diagnosed ◽  
Cd4 Counts ◽  
Poor Countries ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Resource Poor ◽  
The Mean ◽  
Tract Infections ◽  
Cd4 Cell

Background: A rise in HIV/AIDS is observed in resource poor countries like India despite successful implementation of control programmes. Most of these deaths recorded in cases of AIDS are because of opportunistic infections [OI] and other malignancies. The reason may be attributed to the effective destruction or decrease in CD4 cells which play a pivotal role in immune system. OI cause substantial morbidity and hospitalization, economical loss to the society and shorten the survival time of HIV patient. The objective of this study was to evaluate the different type of infections and identify the frequent pathogens affecting the HIV patients who are attending a tertiary care hospital in India. The clinical profile of these patients was studied and proportion of CD4 counts with respect to their type of infection and pathogen is also evaluated.Methods: A prospective cross sectional study was conducted for one year period. Clinical samples were collected from all the newly diagnosed cases of HIV and performed various staining techniques and cultured on appropriate culture media.  All the isolates were identified as per standard guidelines. Serological evaluation for IgM antibodies for toxoplasma was done by ELISA. CD4 counts were estimated by FACS.Results: Tuberculosis was the commonest (67%) OI in HIV cases, followed by candidiasis (61.5%), respiratory tract infections (50%), gastro intestinal tract infections (44%) and meningitis (38%) in our study. The mean CD4 cell counts in the study was 267.11cells/µl. The commonest fungal pathogen was C.albicans and Cryptosporidium parvum the parasitic pathogen. The mean CD4 cell counts were lesser in parasitic infections when compared to bacterial and fungal infections. Six cases of P.jiroveci pneumonia were identified in our study. Mortality was recorded among the HIV cases with CD4 cell counts <50 cells/ µl.Conclusions: Early diagnosis and prompt treatment of OIs contributes to increased life expectancy among infected patients, delaying the progression to AIDS. This study helps the clinicians in proper guidance to come up with right diagnosis and early response to manage the patients in resource poor countries like India.

Abstract TP106: Adventitial T Cell Infiltrates Are Related to Brain Atherosclerosis in Hiv-infected Individuals, but Not With Advanced Immunosuppression

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adele Shenoy ◽  
Andrew Dwork ◽  
Jose Gutierrez ◽  
Susan Morgello
Keyword(s):  
T Cell ◽  
Opportunistic Infections ◽  
Immunohistochemical Analysis ◽  
Brain Inflammation ◽  
Arterial Stenosis ◽  
Hiv Status ◽  
Cd4 Counts ◽  
Brain Arteries ◽  
Large Brain ◽  
Quantitative Score

Background: HIV-infected individuals may display chronic brain inflammation. It is unclear whether this inflammation may play a role in brain arterial pathologies that predispose patients with HIV to stroke. We tested the hypothesis that T cell infiltrates would be associated with brain arterial pathology. Methods: Large brain arteries from 162 patients (84 with HIV) were used in immunohistochemical analysis to detect CD3, a pan T cell marker. A semi-quantitative score of 0 to 3 (absent, mild, moderate, severe) was created by visually rating CD3+ cells within each arterial layer (intima, media, and adventitia). Arterial stenosis, lumen-to-wall ratio and presence of atherosclerosis were measured in each arterial segment of the circle of Willis using previously reported methods of good to excellent reliability. All models were adjusted for co-dependence between arteries of the same subject as well as for age, sex, ethnicity, vascular risks factors, cocaine use and artery type and location. Results: Brain arteries from HIV+ individuals had lower adventitial CD3 scores than HIV- (B = -1.65, p = 0.004). Further stratification demonstrated that the decreased arterial CD3 score was significant only among HIV+ subjects with premortem CD4 counts < 200 cells/μl (B = -2.28, p <0.001). Among HIV+ individuals with premortem CD4 counts ≥ 200 cells/μl, CD3 arterial scores were associated with brain atherosclerosis (B = 0.74, p=0.04). Independent of HIV status, CD3 score was associated with decreased lumen-to-wall ratio (B = -0.37, p = 0.02) and percentage luminal stenosis (B = 1.99, p = 0.004). Among HIV+ cases, higher CD3 score was noted with higher CD4 count at death (per 50, B=0.43, P=0.001), hypertension (B=7.14, P<0.001), male sex (B=6.29, P=<0.001) and prior opportunistic infections (B=3.24, P=0.008) while a lower CD3 score was noted among diabetics (B=-5.36, P<0.001) and reported use of antiretroviral at death (B=-1.39, P=0.01). Conclusions: Among HIV+ individuals with premortem CD4 counts ≥ 200, there exists an association between brain arterial lymphocytic activity with atherosclerosis. These findings may suggest a role for lymphocytic inflammation in HIV-related atherosclerosis in the setting of immune reconstitution.

Drug Metabolism and Disposition Genes in Israeli HIV Patients: MDR1 and CYP3A4 Polymorphisms May Affect Susceptibility to HIV but Not the Course of the Disease.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1434-1434
Author(s):  
Meirav Kedmi ◽  
Sara Bar Cohen ◽  
Michelle Hauzi ◽  
Shlomo Maayan ◽  
Deborah Rund
Keyword(s):  
Hiv Infection ◽  
Ethnic Group ◽  
Ethnic Groups ◽  
Mononuclear Cells ◽  
Opportunistic Infections ◽  
Statistical Significance ◽  
Cd4 Count ◽  
Multidrug Resistance Gene ◽  
Cd4 Counts ◽  
Over Time

Abstract Background: Some studies have suggested a relationship between different alleles of the multidrug resistance gene MDR1, and the course of HIV in treated or untreated patients (pts). It is controvertial whether polymorphisms alter the susceptibility to HIV infectivity. We therefore studied the C3435T polymorphism in MDR1, which may influence HIV. The normal allele has been associated with higher MDR1 activity than the polymorphic allele (Hitzl, 2001). We also studied the A to G polymorphism in the NFSE element of the promoter of the CYP3A4 gene, which metabolizes many important drugs. Methods: 96 pts, of either Ethiopian (57) or Caucasian (39) ethnicity, and 276 controls of these ethnic groups were studied using PCR based techniques. MDR1 activity was analyzed on peripheral blood mononuclear cells of 65 pts using rhodamine extrusion. CD4 counts, clinical course and opportunistic infections were recorded at the Hadassah Hospital AIDS Center where all pts are followed. Our pts are highly compliant with medical therapy and followup. Statistical significance was determined using the Cochrane-Armitage Trends test. Results: We found that the C allele of MDR1 C3435T was highly associated with being an HIV patient (p&lt;0.0001) as compared to controls. The reverse was true for the T allele. This association was found for all patients and also separately for each ethnic group. To analyze if this polymorphism affects the course of HIV, we compared CD4 counts in the patients of both ethnic groups according to genotypes. CD4 counts did not differ according to MDR1 C3435T genotype. Furthermore, C3435T genotypes did not affect the change in CD4 count over time in treated pts. CD4 counts rose following antiretroviral therapy in all pts. Twenty-eight of the pts were positive for HIV infection but were not yet treated. In untreated pts, the TT patients had more severe CD4 deficiency over time compared to CC pts. Our sample size is small, but this concurs with the findings of Lee who found that increased MDR1 activity correlated with decreased viral production (Lee, CG, FASEB J, 2000). Rhodamine extrusion did not vary according to MDR1 C3435T genotype. Opportunistic infections were rare and unaffected by genotype. For the CYP3A4 promoter polymorphism, we found a significantly increased probability of being infected with HIV (p&lt;0.0001) with the presence of the C allele, both in heterozygotes and in homozygotes. There were significantly fewer T alleles among the controls as compared to HIV pts. However when analyzed by ethnic group, this association was only found to be significant for Ethiopians and not for Caucasians (Ethiopians: p&lt; 0.0232 compared to p=0.44). There were no differences found in CD4 count, in treated or untreated patients, or in opportunistic infections according to CYP3A4 genotype. Conclusions: We conclude that for Israeli patients (Ethiopians and Caucasians), susceptibility to HIV infection may be altered according to MDR1 genotype. The C allele was highly associated with infection with HIV for both ethnic groups, as compared to normal controls. For Ethiopians, the CYP3A4 genotype may influence the predisposition to HIV infection (the C allele being associated with being a patient as compared to controls). However, the course of the disease and unsorted lymphocyte MDR1 activity were not influenced by the polymorphisms which we studied.

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