Relationship of CD4+ Cell Count to the Risk of Developing Opportunistic Infections and Cancer

An outpatient HIV clinic was opened in March 2005 in Binh Thanh District, a poor section of Ho Chi Minh City, Vietnam. Over 1500 patients were seen in the first year. The average age of patients was 27 years. Men represented 77% of the clinic population, women, 23% and children under the age of 16 years of age, 5% of the population. The most common risk factor among men was being an injecting drug user (IDU), 76%, and among women, being married to an IDU HIV-positive man, 35%. Physical signs of disease were uncommon: lymphadenopathy in 24% and hepatomegaly and splenomegaly in 4% and 3%, respectively. Men and women were anaemic at presentation, with a mean haemoglobin of 11.9 g/dL and 11.1 g/dL, respectively. An overwhelming majority of patients had profound immunodeficiency. The mean CD4+ cell count was 164 cells/mL and the median was 69 cells/mL. No correlation was found between the World Health Organization's stage of disease and the CD4+ cell count. Thus, the former is a poor predictor of immunity in this population. Data regarding opportunistic infections diagnosed at the first visit were studied. Candidiasis of the oral pharynx, oesophagus or vagina was found in 34.5% of the patients, and pulmonary and extrapulmonary tuberculosis was found in 32% of the patients. Pneumocystis carinii pneumonia (PCP) was diagnosed in only 3% of the patients. Cotrimoxazole prophylaxis is advocated for HIV-infected Vietnamese, but the incidence of PCP is negligible and resources could be spent elsewhere. The various opportunistic infections seen in this resource-poor clinic setting is likely to be a pattern of presentation of HIV-infected Vietnamese for some time to come.

Download Full-text

The THE SPECTRUM OF OPPORTUNISTIC INFECTIONS AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV/AIDS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY AT MERPATI CLINIC, BALI, INDONESIA: A RETROSPECTIVE STUDY

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2020v12i6.37682 ◽

2020 ◽

pp. 68-71

Author(s):

NOVIANA JOENPUTRI ◽

KETUT SURYANA

Keyword(s):

Retrospective Study ◽

Marital Status ◽

Cell Count ◽

Associated Factors ◽

Opportunistic Infections ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Highly Active ◽

Living With Hiv ◽

Cd4 Cell

Objective: Infections contributed to higher morbidity and mortality in people living with HIV/AIDS (PLWHA) in both developed and developing countries. This study aimed to describe the spectrum of opportunistic infections (OIs) and associated factors among PLWHA on highly active antiretroviral therapy (HAART) at Merpati Clinic, Wangaya Regional General Hospital in Denpasar, Bali. Methods: This was a retrospective study. All of PLWHA, who still receiving HAART at Merpati Clinic from January 2018 to January 2020, who met inclusion and exclusion criteria, were included as subjects in this study. All data were collected through a review of the complete medical record of patients. Results: The prevalence of OIs in this study was 43.4%. Most PLWHA who experienced OIs were male (68.8%), age ≤40 y old with a median of age 36 y old, educational status senior high school (57.7%), married (62.1%), employed (89.7%), CD4 cell count ≥ 200 cells/µl (67.6%) and transmission route of HIV non-Intravenous (IV) drug user (99.2%). Sex, age, marital status, and CD4 cell count were significantly associated with OIs, p=0.000, p=0.005, p=0.005, and p=0.000, respectively. Conclusion: The commonest OI in this study was pulmonary tuberculosis. The presence of OIs was associated with sex, age of HIV diagnosis, marital status, and CD4 cell count. With the knowledge of OIs spectrum, clinicians are expected to be able to prevent, diagnose and treat OIs promptly to decrease the morbidity and mortality caused by OIs efficiently.

Download Full-text

Slowly progressive fatal PML-IRIS following antiretroviral initiation at CD4+ nadir of 350 cells/mm3 despite CD4+ cell count rise to 900 cells/mm3

International Journal of STD & AIDS ◽

10.1177/0956462419835966 ◽

2019 ◽

Vol 30 (8) ◽

pp. 810-813

Author(s):

Mani Ratnesh Sandhu ◽

Ronnye Rutledge ◽

Matthew Grant ◽

Amit Mahajan ◽

Serena Spudich

Keyword(s):

Cell Count ◽

Immune Reconstitution ◽

Opportunistic Infections ◽

Jc Virus ◽

Virus Antigen ◽

Cd4 Cell Count ◽

Cd4 Cell ◽

Inflammatory Syndrome ◽

Continuous Progression

AIDS-related progressive multifocal leukoencephalopathy (PML)-immune reconstitution inflammatory syndrome (IRIS) is a central nervous system inflammatory syndrome where immune response to John Cunningham (JC) virus antigen following antiretroviral therapy (ART) causes breakdown of the blood–brain barrier. We report a unique case of PML-IRIS, which presented with dystonic choreoathetosis after initiation of ART at a CD4+ cell count of 350 cells/mm3. This report shows continuous progression of the disease over a period of two years, despite robust immune reconstitution. The worsening of neurological symptoms, persistent positivity of JC virus in CSF, and progressive inflammatory picture on MR scans in the setting of a CD4+ cell count of 900 cells/mm3 highlight a different variant of PML-IRIS, and challenge the role of CD4+ cell count in diagnosing opportunistic infections in HIV/AIDS patients.

Download Full-text

Initiation of highly active antiretroviral therapy in advanced AIDS with CD4 < 50 cells/mm3 in a resource-limited setting: efficacy and tolerability

International Journal of STD & AIDS ◽

10.1258/0956462053420121 ◽

2005 ◽

Vol 16 (3) ◽

pp. 243-246 ◽

Cited By ~ 8

Author(s):

Somnuek Sungkanuparph ◽

Sasisopin Kiertiburanakul ◽

Weerawat Manosuthi ◽

Wiphawee Kiatatchasai ◽

Asda Vibhagool

Keyword(s):

Antiretroviral Therapy ◽

Cell Count ◽

Highly Active Antiretroviral Therapy ◽

Adverse Drug Events ◽

Opportunistic Infections ◽

Transcriptase Inhibitor ◽

Cd4 Cell Count ◽

Hiv Rna ◽

Highly Active ◽

Cd4 Cell

In developing countries, patients often present late with advanced AIDS and a very low CD4 cell count. A retrospective cohort study was conducted in HIV-infected patients who had been initiated into highly active antiretroviral therapy (HAART) with CD4 cell count <50 cells/mm3. There were 159 patients of mean age 36.6 years and 60.4% had previous major opportunistic infections. Mean CD4 was 22 cells/mm3 and 80% had HIV RNA>100,000 copies/mL. The majority of HAART regimens is non-nucleoside reverse transcriptase inhibitor-based (81.8%). In as-treated analysis, 50, 71.2, 79.7, 79.4, and 80.1% of patients achieved undetectable HIV RNA (<50 copies/mL) at 12, 24, 36, 48, and 60 weeks, respectively. The corresponding mean CD4 counts were 95, 125, 166, 201, and 225 cells/mm3. Twenty two patients (13.8%) had adverse drug events and half of these had to discontinue HAART. Initiation of HAART in advanced AIDS with CD4 cell count <50 cells/mm3 is effective, safe, and well tolerated and should not be delayed.

Download Full-text

RELATIONSHIP OF HIV-HBV CO-INFECTION WITH CD4 CELL COUNT AND ALANINE TRANSAMINASE LEVELS IN ANTI-RETROVIRAL THERAPY-NAïVE PATIENTS

BMJ Global Health ◽

10.1136/bmjgh-2016-000260.107 ◽

2017 ◽

Vol 2 (Suppl 2) ◽

pp. A40.3-A41

Author(s):

Kalo Musukuma ◽

Roma Chilengi ◽

Rosalia Dambe ◽

Benjamin Usadi ◽

Michael Vinikoor

Keyword(s):

Cell Count ◽

Alanine Transaminase ◽

Cd4 Cell Count ◽

Relationship Of ◽

Cd4 Cell

Download Full-text

Protein Status and CD4+ Cell Count in HIV Patients on Highly Active Anti-Retroviral Therapy

Academic Journal of Life Sciences ◽

10.32861/ajls.52.10.14 ◽

2019 ◽

pp. 10-14

Keyword(s):

Cell Count ◽

Total Protein ◽

Opportunistic Infections ◽

Hiv Patients ◽

Cd4 Cell Count ◽

Highly Active ◽

Protein Status ◽

Cell Counts ◽

Cd4 Cell

Background of Study: Malnutrition is associated with repeated opportunistic infections, rapid disease progression, and an increase in the incidence of human immunodeficiency virus (HIV) related mortality. The ability of anti-retroviral therapy (ART) in boosting the immune system depends on the nutritional status of the HIV patient. Aim: The study aimed at investigating the protein status and CD4+ cell counts in HIV patients taking highly active ART. Materials and Methods: The case-control study comprising of a total of 80 participants, compared the protein status and CD4+ cell count among baseline (ART-naïve n=20), switch (ART-resistant n=20), ART follow-up (n=20) patients, and apparently healthy controls (n=20). Results: The total protein of baseline patients was significantly (P<0.01) higher than that of the switch, follow-up, and controls. The CD4+ cell count of baseline patients was significantly (P=0.000) low compared to follow-up patients and controls. Total protein level and CD4+ cell count of switch patients were significantly (P=0.000) lower than that of follow-up patients and controls. Total protein of follow-up patients was significantly (P<0.02) higher than that of controls, while the CD4+ cell count of follow-up patients was significantly (P=0.000) lower than that of controls. Conclusion: The present study observed low protein along with low CD4+ cell count in switch patients, while a good outcome was observed in follow up patients.

Download Full-text

A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala

Journal of Fungi ◽

10.3390/jof7040268 ◽

2021 ◽

Vol 7 (4) ◽

pp. 268

Author(s):

Narda Medina ◽

Ana Alastruey-Izquierdo ◽

Oscar Bonilla ◽

Osmar Gamboa ◽

Danicela Mercado ◽

...

Keyword(s):

Cell Count ◽

Opportunistic Infections ◽

Screening Program ◽

Rapid Screening ◽

Newly Diagnosed ◽

Hiv Patients ◽

Cd4 Cell Count ◽

One Year ◽

Advanced Hiv Disease ◽

Cd4 Cell

Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 < 350 cells/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p < 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count < 350 cells/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.

Download Full-text

Hubungan Jumlah Cluster of Differentiation 4 (CD4) dengan Infeksi Oportunistik Pada Pasien HIV/AIDS di Rumah Sakit Umum Daerah (RSUD) DOK II Jayapura

JURNAL BIOLOGI PAPUA ◽

10.31957/jbp.427 ◽

2018 ◽

Vol 7 (1) ◽

pp. 16-21

Author(s):

Mirna Widiyanti ◽

Hotma Hutapea

Keyword(s):

Cell Count ◽

Opportunistic Infection ◽

Opportunistic Infections ◽

Chi Square ◽

Cross Sectional ◽

Cd4 Cell Count ◽

Chi Square Test ◽

Cd4 Cell ◽

The Relationship ◽

Hiv Aids

Human Immunodeficiency Virus (HIV) is an infection that attacks and weakens the immune system. HIV infection causes a decrease in the number of Cluster Differentiation 4 (CD4) thereby increasing the progression of the disease and lead to high risk of opportunistic infections (OI). The purpose of this study was to examine the relationship between CD4 cell count with opportunistic infections in patients infected with HIV/AIDS. Analytical research methods using cross-sectional design, by taking medical records. The population in this study were 67 patients with HIV/AIDS in the VCT Clinic Dok II Hospital Jayapura 2014. Data were processed with the Chi Square test hypotheses. Based on the results of hypothesis testing of 67 patients, there were 21 people have opportunistic infections. Tuberculosis is an opportunistic infection that is most common (17.9%). Significance of the relationship seen in the low CD4 counts (< 350 cells/mm3) and found value of 0.02 (CI 95%) which indicates that there is a relationship if p<0.05. Conclusion: there is a relationship between CD4 cell count with opportunistic infections.Key words: CD4, opportunistic infection, HIV/AIDS, hospital.

Download Full-text

769. Mortality Among Inpatients After the Initiation of ‘Treat All’ With Dolutegravir in Botswana

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.959 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S429-S429

Author(s):

Amanda E Klinger ◽

Ryan J Kronen ◽

Tomer Barak ◽

Patricia Mophuthegi ◽

Joseph Makhema ◽

...

Keyword(s):

Cell Count ◽

Opportunistic Infections ◽

Community Acquired Pneumonia ◽

People Living With Hiv ◽

Inpatient Mortality ◽

Cd4 Cell Count ◽

Art Initiation ◽

Treat All ◽

Living With Hiv ◽

Cd4 Cell

Abstract Background Botswana was the first African country to implement a ‘treat all’ dolutegravir (DTG)-based treatment program for all adults. We studied whether this transition made a short-term impact on inpatient mortality among people living with HIV (PLWHIV). Methods From Dec 2015-Nov 2017, data were collected prospectively on all patients admitted to the medical wards of a district hospital in Botswana. Tenofovir/emtricitabine/efavirenz (TDF/FTC/EFV) was the first-line recommended antiretroviral treatment (ART) regimen for all ART-naïve adults with CD4 < 350 until May 2016, when it was replaced by TDF/FTC/DTG without CD4 restriction (‘treat all’). Multivariable logistic regression was used to compare mortality by ART regimen. Results Of 1,969 patients admitted, 41.5% were PLWHIV and of these 62.9% were on ART prior to admission. Before ‘treat all’, 160 (58.0%) of 276 PLWHIV were on ART prior to admission, and post-implementation 354 (65.4%) of 541 PLWHIV were on ART prior to admission (p=0.01). Among 315 patients on EFV-based ART and 85 on DTG-based ART prior to admission, demographics were similar (Table 1), except for more recent ART initiation with DTG, and lower median CD4 cell count with DTG (256 vs. 339 cells/mm3). Tuberculosis (TB) and community acquired pneumonia were the leading causes of hospitalization for both regimens. Death occurred in 178 (21.8%) PLWHIV, including 29% not on ART and 19% on any ART (p=0.003). Overall, 38% who initiated ART < 3 months prior to admission died (23.7% DTG, 48.8% EFV), and 36% with CD4 cell count < 50 cells/mm3 died (42.9% DTG, 30.8% EFV). Fewer deaths occurred among those on EFV (18%) compared with those on DTG (27%). However, controlling for CD4 count and timing of ART start, the risk of mortality among those on DTG and EFV was similar (aRR 1.08, 95% CI 0.62, 1.87). TB was the leading cause of death (40.1% off ART, 31.8% on DTG, 22.2% on EFV). Table 1. Demographics, clinical characteristics, and outcomes of people living with HIV (PLWHIV) admitted to Scottish Livingstone Hospital, stratified by ART regimen prior to admission. Conclusion We found no improvement in inpatient mortality among PLWHIV during the shift to ‘treat all’ with DTG-based ART in Botswana. Decreasing high inpatient HIV mortality will require increased testing in the community to detect and treat PLWHIV prior to disease progression, and improved screening for opportunistic infections. Disclosures All Authors: No reported disclosures

Download Full-text