The impact of diabetes on CD4 recovery in persons with HIV in an urban clinic in the United States

2017 ◽  
Vol 29 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Julie A Zuniga ◽  
Kirk A Easley ◽  
Neeta Shenvi ◽  
Minh L Nguyen ◽  
Marcia Holstad
Keyword(s):  
African American ◽  
T Cell ◽  
Cell Count ◽  
African American Women ◽  
Cd4 T Cell ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Cd4 Cell ◽  
The Impact ◽  
Cd4 T Cell Count

The purpose of this study was to exam the impact of type 2 diabetes mellitus (T2DM) on CD4 cell count trends in adults with HIV. In a longitudinal retrospective study in an urban primary care HIV clinic in the southeastern United States from 2010 to 2012, patients with HIV medical charts were audited to obtain their CD4 cell count, diabetes status, weight, and demographic information. Rates of increase of CD4 T cell count (i.e. slopes) were obtained using a linear mixed-effects model. Most of the HIV–T2DM cohort (n = 262) and HIV-only cohort (n = 2399) were African American (76%) and male (77%). The CD4 T cell counts were consistently higher in the HIV–T2DM cohort ( p < .0001). The mean rate of CD4 T cell count increase (mean ± SE) was 63 ± 9 cells/µl/year in HIV–T2DM African American women and 28 ± 7 cells/µl/year in HIV–T2DM African American men ( p = 0.003). In the multivariable slope analysis, the CD4 T cell count increase was significantly faster for HIV–T2DM African American women than for all other patients (mean difference = 30/cells/µl/year, 95% CI: 13–47; p < 0.001). Gender, race/ethnicity, and the diagnosis of diabetes influenced the recovery of CD4 cell counts.

scholarly journals PIMATM point-of-care testing for CD4 counts in predicting antiretroviral initiation in HIV-infected individuals in KwaZulu-Natal, Durban, South Africa

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Mandisa Skhosana ◽  
Shabashini Reddy ◽  
Tarylee Reddy ◽  
Siphelele Ntoyanto ◽  
Elizabeth Spooner ◽  
...  
Keyword(s):  
South Africa ◽  
T Cells ◽  
T Cell ◽  
Antiretroviral Therapy ◽  
Cell Count ◽  
Point Of Care ◽  
Cd4 T Cell ◽  
Cell Counts ◽  
Kwazulu Natal ◽  
Cd4 T Cell Count

Introduction: Limited information is available on the usefulness of the PIMATM analyser in predicting antiretroviral treatment eligibility and outcome in a primary healthcare clinic setting in disadvantaged communities in KwaZulu-Natal, South Africa.Materials and methods: The study was conducted under the eThekwini Health Unit, Durban, KwaZulu-Natal. Comparison of the enumeration of CD4+ T-cells in 268 patients using the PIMATM analyser and the predicate National Health Laboratory Services (NHLS) was undertaken during January to July 2013. Bland-Altman analysis to calculate bias and limits of agreement, precision and levels of clinical misclassification at various CD4+ T-cell count thresholds was performed.Results: There was high precision of the PIMATM control bead cartridges with low and normal CD4+ T-cell counts using three different PIMATM analysers (%CV < 5). Under World Health Organization (WHO) guidelines (≤ 500 cells/mm3), the sensitivity of the PIMATM analyser was 94%, specificity 78% and positive predictive value (PPV) 95%. There were 24 (9%) misclassifications, of which 13 were false-negative in whom the mean bias was 149 CD4+ T-cells/mm3. Most (87%) patients returned for their CD4 test result but only 67% (110/164) of those eligible (≤ 350 cells/mm3) were initiated on antiretroviral therapy (ART) with a time to treatment of 49 days (interquartile range [IQR], 42–64 days).Conclusion: There was adequate agreement between PIMATM analyser and predicate NHLS CD4+ T-cell count enumeration (≤ 500 cells/mm3) in adult HIV-positive individuals. The high PPV, sensitivity and acceptable specificity of the PIMATM analyser technology lend it as a reliable tool in predicting eligibility and rapid linkage to care in ART programmes.Keywords: HIV; Point of Care; PIMATM CD4+ T cell counts; antiretroviral therapy; prediction/eligibility; South Africa

scholarly journals Intestinal parasitic infection among the HIV-infected patients in Nepal

2013 ◽  
Vol 7 (07) ◽  
pp. 550-555 ◽  
Author(s):  
Bishnu Raj Tiwari ◽  
Prakash Ghimire ◽  
Sarala Malla ◽  
Bimala Sharma ◽  
Surendra Karki
Keyword(s):  
T Cell ◽  
Cell Count ◽  
Parasitic Infection ◽  
Cd4 T Cell ◽  
Parasitic Infections ◽  
Intestinal Parasitic Infection ◽  
Infected People ◽  
Tb Treatment ◽  
Cell Counts ◽  
Cd4 T Cell Count

Introduction: Intestinal parasitic infection has been a significant problem in HIV patients, worldwide. In this study, we aimed to measure the prevalence and identify the factors associated with intestinal parasitic infection in people infected with HIV and attending National Public Health Laboratory in Kathmandu, Nepal, for CD4 T-cell count. Methodology: An analytical cross-sectional study in 745 HIV-infected people attending for CD4 T-cell count was conducted. Results: The prevalence of intestinal parasitic infection was 22.4% (95% CI 19.5 to 25.5). In univariate analysis, age, sex, longer time since diagnosis of HIV, CD4 T-cell count of <200/µL, diarrhoea, marital status, and being under tuberculosis (TB) treatment were significantly associated with increased odds of intestinal parasite infection. However, in the logistic regression model, only the CD4 T-cell count of <200/µL (adjusted OR=4.2, 95% CI 2.5 to 7.0), diarrhoea (adjusted OR=2.8, 95% CI 1.8 to 4.3) and being under TB treatment (adjusted OR=2.9, 95% CI 1.8 to 4.6) remained as significant predictors. On stratification, CD4 T-cell count of <200/ µL was independently associated with higher odds of protozoal as well as helminthes infection. The parasites Cryptosporidium and Cyclospora were observed only in participants with CD4 T-cell counts <200/µL. Conclusions: Both protozoal and helminthic intestinal parasitic infections are common in HIV-infected people seeking care in healthcare facilities. The poor immune status as indicated by low CD4 T-cell count and TB may account for such a high risk of parasitic infection.

Prognostic value of an immune score combining intra- and peritumoral T-cell subset density in patients with pancreatic adenocarcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4060-4060
Author(s):  
Simon Turcotte ◽  
Yannic McNicoll ◽  
Genevieve Soucy ◽  
Louis Gaboury ◽  
Real W. Lapointe ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Count ◽  
Pancreatic Adenocarcinoma ◽  
Prognostic Value ◽  
Cd8 T Cell ◽  
Tnm Staging ◽  
Cd4 T Cell ◽  
Cell Counts ◽  
Immune Score ◽  
Cd4 T Cell Count

4060 Background: Immune scoring based on T-cell subsets and density can add prognostic value to conventional TNM staging for patients with solid tumors, but limited data are available for pancreatic adenocarcinoma. Methods: Using tissue microarrays, CD3, CD4, CD8, CD45RO, and FOXP3 T-cells were quantified by immunohistochemistry in the intratumoral (IT) compartment and peritumoral (PT) parenchyma of 111 consecutively resected specimens. T-cell counts were correlated with patient overall survival, disease-free survival, and time to recurrence (OS, DFS, TTR) by Cox regression, controlling for clinicopathological factors. An immune score (IS) based on IT CD4 T-cell count > median, PT CD8 T-cell count ≤ median, and IT/PT CD3 T-cell ratio >1, grouped patients into high, intermediate, or low categories if all 3, 1 to 2, or none of these immune features were present, respectively. Results: Median follow-up time was 20 months, and 85% of patients either died or recurred during the study period. By univariate analysis, PT CD8 T-cell count was associated with shorter OS (p=0.02), whereas both IT CD4 T-cell count and IT/PT CD3 T-cell ratio were associated with longer OS (p=0.01 and p=0.05, respectively). Alone, none of these immune features predicted TTR. Combined into an IS, patients in the high (n=23), intermediate (n=60), or low (n=23) categories had significantly different OS (respective medians 30, 17, and 13 months, log-rank p=0.01), DFS (28, 16, and 12 months, p=0.01), and TTR (21, 14, and 10 months, p=0.02). By multivariate analysis, the association between IS and clinical outcomes was independent of tumor size, extra-pancreatic invasion, and nodal metastases (TNM staging). The IS discriminated outcomes among patients with nodal metastases (n=80), such that node-positive patients with a high IS had a median survival similar to node-negative patients (30 and 33 months, p=0.7). FOXP3 and CD45RO T-cell counts did not appear to add prognostic value to the IS. Conclusions: An immune score that combines specific T-cell location and density may have prognostic value in patients with resected pancreatic adenocarcinoma, independently from pathologic features currently used for staging.

scholarly journals Determination of CD4+ T- Lymphocytes in Healthy Children of Kathmandu

2018 ◽  
Vol 16 (3) ◽  
pp. 325-329
Author(s):  
Sapana Karn ◽  
Manjula Bhattarai ◽  
Ramanuj Rauniyar ◽  
Anurag Adhikari ◽  
Pratik Karna ◽  
...  
Keyword(s):  
T Cell ◽  
Cord Blood ◽  
Cell Count ◽  
T Lymphocyte ◽  
Cd4 T Cell ◽  
Specific Reference ◽  
Healthy Children ◽  
Cross Sectional ◽  
Cell Counts ◽  
Cd4 T Cell Count

Background: The cluster differentiation (CD) of T-cell is the good marker for the immunological competence study. Nepal does not have a reference value for CD4+ T cell count and percentage for children, which severely limits the prospect of pediatric prognosis.Methods: This cross-sectional study was conducted in Kathmandu valley where total 207 children of age 0-14 year age group were recruited in this study. We analyzed 50 cord blood and 157 peripheral blood samples in order to calculate the absolute count of CD4+ T lymphocyte using Fluorescence-activated cell sorting methodology.Results: The reference range for absolute CD4+ T cell count was found to be 634-4040 cells/µL(mean1470; median: 1335 and 95% CI [1322-1617]) for male children and 491-2922 cells/µL (mean: 1443 median: 1326 and95% CI [1298-1588]) for the female children.We also observed elevated CD4 to the CD3 ratio in younger children (0.67 from cord blood Vs 0.53 from 10-14yr) compared to older ones.Conclusions: The observed CD4+ T cell counts among healthy children of Kathmandu highlights the gender differences skewed for male as well the need of defining specific reference values for other lymphocyte subsets as well in a country like Nepal which has a population with diverse genetic and socio-cultural parameters.Keywords: CD4+ T lymphocyte; children; HIV; immunophenotyping; Kathmandu; Nepal.

scholarly journals Prospective study of opportunistic infections among HIV infected patients in VSS Institute of Medical Science and Research, Burla, Sambalpur, Odisha, India

2018 ◽  
Vol 5 (3) ◽  
pp. 566
Author(s):  
P. K. Bariha ◽  
M. K. Mohapatra ◽  
B. K. Kullu ◽  
P. C. Karua ◽  
S. B. Biswal ◽  
...  
Keyword(s):  
T Cell ◽  
Prospective Study ◽  
Cell Count ◽  
Opportunistic Infections ◽  
Oral Candidiasis ◽  
Medical Science ◽  
Cd4 T Cell ◽  
Female Ratio ◽  
Cell Counts ◽  
Cd4 T Cell Count

Background: HIV destroys the CD4+T cells progressively thus making the HIV infected persons susceptible to a number of opportunistic infections (OIs).Methods: The study was conducted in the Medicine Department and ART Centre, VIMSAR. It is a prospective study from July 2016 to September 2017.Results: 86 patients register, detail history, clinical examination and investigation were done and then the data is complying in detail. Most of the patients were male (72%) male female ratio is 2.6:1. The majority of patients presented with fever, weight loss and anorexia seen in more than 73% of the study population.Conclusions: (42%) cases belonged to the CD4+T cell count range of 101-200/µl with aCD4+T cell count of 183/µl, so there is increased chance of hospitalization in patients having CD4+T cell count below 200/µl. The most common OI was tuberculosis (51%) with pleural effusion as its commonest manifestation. The second most common OI was candidiasis (43%) with most cases suffering from oral candidiasis was seen to occur at higher CD4+T cell counts than tuberculosis.

Determination of CD4+ T- Lymphocytes in Healthy Children of Kathmandu

2018 ◽  
Vol 16 (3) ◽  
pp. 325-329
Author(s):  
Sapana Karn ◽  
Manjula Bhattarai ◽  
Ramanuj Rauniyar ◽  
Anurag Adhikari ◽  
Pratik Karna ◽  
...  
Keyword(s):  
T Cell ◽  
Cord Blood ◽  
Cell Count ◽  
Reference Value ◽  
Cd4 T Cell ◽  
Specific Reference ◽  
Healthy Children ◽  
Cross Sectional ◽  
Cell Counts ◽  
Cd4 T Cell Count

Background: The cluster differentiation (CD) of T-cell is the good marker for the immunological competence study. Nepal does not have a reference value for CD4+ T cell count and percentage for children, which severely limits the prospect of pediatric prognosis.Methods: This cross-sectional study was conducted in Kathmandu valley where total 207 children of age 0-14 year age group were recruited in this study. We analyzed 50 cord blood and 157 peripheral blood samples in order to calculate the absolute count of CD4+ T lymphocyte using Fluorescence-activated cell sorting methodology.Results: The reference range for absolute CD4+ T cell count was found to be 634-4040 cells/µL (mean1470; median: 1335 and 95% CI [1322-1617]) for male children and 491-2922 cells/µL (mean: 1443 median: 1326 and 95% CI [1298-1588]) for the female children. We also observed elevated CD4 to the CD3 ratio in younger children (0.67 from cord blood Vs 0.53 from 10-14yr) compared to older ones.Conclusions: The observed CD4+ T cell counts among healthy children of Kathmandu highlights the gender differences skewed for male as well the need of defining specific reference values for other lymphocyte subsets as well in a country like Nepal which has a population with diverse genetic and socio-cultural parameters.

scholarly journals Necrotizing Periodontal Diseases in a Semirural District of South Africa

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Neil Hamilton Wood ◽  
Elaine Blignaut ◽  
Johan Lemmer ◽  
Robin Meyerov ◽  
Liviu Feller
Keyword(s):  
T Cell ◽  
Cell Count ◽  
Neutrophil Count ◽  
Periodontal Diseases ◽  
Clinical Signs ◽  
Cd4 T Cell ◽  
Cell Counts ◽  
Hiv Serostatus ◽  
Hiv Seropositive ◽  
Cd4 T Cell Count

Objectives. The aim of this study was to characterize the lesions of necrotizing gingivitis (NG) and necrotizing periodontitis (NP) with regard to extent and severity, and to correlate these parameters with the host HIV serostatus, CD4+ T-cell count, neutrophil count, age, and gender.Methods. Eighty-four consecutive patients, 39 black females and 45 black males aged 20–46 years, diagnosed with NG/NP were recruited to the study over a period of two years.Results. For both HIV-seropositive and -seronegative patients, the mandibular anterior gingiva was most frequently affected; 74% had NG/NP affecting ≥5 gingival tooth sites. Ninety percent of all patients had a mean severity of ≤4 mm. There was no statistically significant association between either extent or severity of NG/NP and HIV serostatus, CD4+ T-cell count, neutrophil count, age, or gender. The difference between the number of HIV-seropositive patients with NG/NP who had CD4+ T-cell counts ≤200 cells/mm3and those who had CD4+ T cell counts of 201–499 cells/mm3was not statistically significant.Conclusion. The clinical signs of NG/NP are similar in HIV-seropositive and -seronegative patients, and are not related to CD4+ T-cell count, to neutrophil count, to gender, or to age.

HIV-1–related Hodgkin lymphoma in the era of combination antiretroviral therapy: incidence and evolution of CD4+ T-cell lymphocytes

Blood ◽  
2011 ◽  
Vol 117 (23) ◽  
pp. 6100-6108 ◽  
Author(s):  
Julia Bohlius ◽  
Kurt Schmidlin ◽  
François Boué ◽  
Gerd Fätkenheuer ◽  
Margaret May ◽  
...  
Keyword(s):  
T Cell ◽  
Antiretroviral Therapy ◽  
Hodgkin Lymphoma ◽  
Cd4 T Cell ◽  
Combination Antiretroviral Therapy ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Cd4 Cell ◽  
Hiv 1

Abstract The risk of Hodgkin lymphoma (HL) is increased in patients infected with HIV-1. We studied the incidence and outcomes of HL, and compared CD4+ T-cell trajectories in HL patients and controls matched for duration of combination antiretroviral therapy (cART). A total of 40 168 adult HIV-1–infected patients (median age, 36 years; 70% male; median CD4 cell count, 234 cells/μL) from 16 European cohorts were observed during 159 133 person-years; 78 patients developed HL. The incidence was 49.0 (95% confidence interval [CI], 39.3-61.2) per 100 000 person-years, and similar on cART and not on cART (P = .96). The risk of HL declined as the most recent (time-updated) CD4 count increased: the adjusted hazard ratio comparing more than 350 with less than 50 cells/μL was 0.27 (95% CI, 0.08-0.86). Sixty-one HL cases diagnosed on cART were matched to 1652 controls: during the year before diagnosis, cases lost 98 CD4 cells (95% CI, −159 to −36 cells), whereas controls gained 35 cells (95% CI, 24-46 cells; P < .0001). The incidence of HL is not reduced by cART, and patients whose CD4 cell counts decline despite suppression of HIV-1 replication on cART may harbor HL.

Intestinal Parasites Infections among HIV Infected Children Under Antiretrovirals Treatment in Yaounde, Cameroon

2019 ◽  
Vol 66 (2) ◽  
pp. 178-186
Author(s):  
William Baiye Abange ◽  
Celine Nguefeu Nkenfou ◽  
Hortense Gonsu Kamga ◽  
Clement Assob Nguedia ◽  
Nelly Kamgaing ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Count ◽  
Intestinal Parasites ◽  
Parasitic Infection ◽  
Cd4 T Cell ◽  
Parasitic Infections ◽  
Blood Samples ◽  
Cryptosporidium Spp ◽  
Cell Counts ◽  
Cd4 T Cell Count

Abstract Background Intestinal parasitic infections are among the most common communicable diseases worldwide, particularly in developing countries. Human immunodeficiency virus (HIV) causes dysregulation of the immune system through the depletion of CD4+ T lymphocytes which gives rise to opportunistic infections. Methodology A cross-sectional study was conducted from January to October 2018. Stool and blood samples were collected from participants aged 1 to 19. Stool samples were analyzed for intestinal parasites. Blood samples were analyzed for HIV and CD4 + T cell counts. Results Out of 214 children enrolled, 119 (55.6%) were HIV infected and 95 (44.4%) were HIV non-infected. All infected children were on antiretroviral treatment (ART). The prevalence of intestinal parasites was 20.2% in HIV infected and 15.8% in non-infected children. Among the 119 HIV infected children, 33 (27.7%) of them had a CD4+ T cell count less than 500 cells/mm3, and amongst them 5.9% had CD4+ T cell count less than 200 cells/mm3. Among HIV infected children, Cryptosporidium spp. was frequently detected, 7/119 (5.9%), followed by Giardia lamblia 5/119 (4.2%) then Blastocystis hominis 3/119 (2.5%) and Entamoeba coli 3/119 (2.5%). Participants on ART and prophylactic co-trimoxazole for &gt;10 years had little or no parasite infestation. Conclusions Although ART treatment in combination with prophylactic co-trimoxazole reduces the risk of parasitic infection, 20.2% of HIV infected children harbored intestinal parasites including Cryptosporidium spp. Stool analysis may be routinely carried out in order to treat detected cases of opportunistic parasites and such improve more on the life quality of HIV infected children.

scholarly journals Gender Prospective: Routes of Transmission and Care Seeking of HIV among HIV Infected Individuals Attending for CD4 T Cell Count in Kathmandu, Nepal

2019 ◽  
Vol 3 (1) ◽  
pp. 1-7
Author(s):  
Bimala Sharma ◽  
Bishnu Raj Tiwari ◽  
Prakash Ghimire ◽  
Sarala Malla
Keyword(s):  
T Cell ◽  
Drug Use ◽  
Cell Count ◽  
Injecting Drug Use ◽  
Cd4 T Cell ◽  
Hiv Care ◽  
Care Seeking ◽  
Commercial Sex ◽  
Cell Counts ◽  
Cd4 T Cell Count

Gender may play important role on routes of transmission and care seeking of HIV among HIV infected individuals. The objective of the study was to assess gender difference on routes of transmission and care seeking of HIV among HIV infected individuals attending National Public Health Laboratory in Kathmandu, Nepal for CD4 T cell count. A cross-sectional study was conducted in 1945 HIV infected people attending for CD4 Tcell count from March, 2005 to December 2008. Of total, 65.6% were males and dominant age group was 20-39 years (78.0%). Median age of the study population was 30, of males 31 and of females 29 years. The dominant routes of transmission were injecting drug-use (41.0%) and commercial sex (36.9%). Males were more likely to report IDU (60.4% versus 4.2%) while females were more likely to report CSW (46% versus 32%) as their routes of transmission. Regarding sex with partner, 42.7% of females and 2.1% of males had reported the acquisition of the infection through their spouses or regular sex partners. Forty percent participants had attended for CD4 T cell count within 12 months since the diagnosis of HIV. Females had attended earlier than males (44% versus 37%) for CD4 T cell count within one year of diagnosis. More males had CD4 T cell counts <200/µl (42.3 % versus 34.7%). The difference on age; routes of transmission , arrival time for CD4 T cell count since the diagnosis of HIV and CD4 T cell count were significant with the sex of participants. Major route of transmission was injecting drug use among males and commercial sex among females. Females were younger, attended earlier for CD4 T cell count and had better immunological status. Gender should be considered in control measures of HIV in Nepal. Key words: Gender prospective, routes of transmission of HIV, care seeking, CD4 T cell count

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