The secular trend in CD4+ T cell count at initiation of antiretroviral therapy in China

Abstract Background: We aimed to look at the trends in CD4 cells counts (at initiation of ART) over calendar years and to investigate its influential factors in Chinese populations.Methods: We searched PubMed, Wanfang, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure to acquire relevant papers published from January 2002 to Twelve 2015. We abstracted the mean or median CD4+ T cell counts from the included studies. Random-effect meta-regressions were used to estimate the mean CD4+ T cell counts across studies and corresponding 95% CIs. Results: A total of 220 eligible articles, which included 426283 HIV-positive individuals, were identified in this meta-analysis. The mean CD4+ T cell counts at ART initiation increased from 136.63 (95%CI=120.63–152.63) cells/µL in 2003 to 199 (95%CI=188.38–209.62) cells/µL in 2014. In the univariate meta-regression model, we found that the estimated change in CD4+ T cell counts at ART initiation was +8.73 cells/μL per year (95% CI= 4.57 to 12.90 cells/μL per year). The highest CD4+ T cell counts at ART initiation (441.00 cells/μL, 95% CI=438.96-186.33 cells/µL) was reported in serodiscordant couples, followed by pregnant women (385.82 cells/μL, 95% CI=327.19-444.44 cells/µL), MSM (293.78, 95% CI=126.59-460.96 cells/µL), and children（267.36 cells/μL, 95% CI=126.65-408.07 cells/µL）. Conclusions: In China, the CD4+ T cell counts at ART initiation have dramatically increased during the past decade. However, there remains a substantial gap between CD4+ T cell counts at ART initiation and the WHO updated HIV treatment guidelines in some groups, highlighting the need for strategies to improve earlier ART initiation.

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Daily Quality Control in CD3+and CD4+T Cell Estimation by the FACSCount System at a Tertiary Care Center in South India

Clinical and Vaccine Immunology ◽

10.1128/cvi.00246-12 ◽

2012 ◽

Vol 19 (10) ◽

pp. 1693-1696 ◽

Cited By ~ 3

Author(s):

Veena V. Ramalingam ◽

Monika Mani ◽

Vijayanand C. Sundaresan ◽

Ramesh J. Karunaiya ◽

Jaiprasath Sachithanandham ◽

...

Keyword(s):

Quality Control ◽

T Cell ◽

South India ◽

Care Center ◽

Tertiary Care ◽

Cd4 T Cell ◽

Internal Quality ◽

Cell Counts ◽

Resource Poor ◽

The Mean

ABSTRACTCD4+T cell count estimations are subject to high variations; hence, in this study, the previous day's tested samples were included routinely as the internal quality controls. The percentages of variation of the 2-day values were analyzed for 280 observations and the mean variation for CD4+and CD3+T cell counts ranged from 5.21% to 9.66%. This method is a good internal quality control (IQC) procedure for the estimation of CD3+and CD4+T cell counts in resource-poor settings.

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A mechanistic model for long-term immunological outcomes in South African HIV-infected children and adults receiving ART

eLife ◽

10.7554/elife.42390 ◽

2021 ◽

Vol 10 ◽

Author(s):

Eva Liliane Ujeneza ◽

Wilfred Ndifon ◽

Shobna Sawry ◽

Geoffrey Fatti ◽

Julien Riou ◽

...

Keyword(s):

T Cell ◽

Mechanistic Model ◽

Health Sector ◽

Cd4 Count ◽

Cd4 T Cell ◽

Long Term Effects ◽

The Public ◽

Art Initiation ◽

Cell Counts

Long-term effects of the growing population of HIV-treated people in Southern Africa on individuals and the public health sector at large are not yet understood. This study proposes a novel ‘ratio’ model that relates CD4+ T-cell counts of HIV-infected individuals to the CD4+ count reference values from healthy populations. We use mixed-effects regression to fit the model to data from 1616 children (median age 4.3 years at ART initiation) and 14,542 adults (median age 36 years at ART initiation). We found that the scaled carrying capacity, maximum CD4+ count relative to an HIV-negative individual of similar age, and baseline scaled CD4+ counts were closer to healthy values in children than in adults. Post-ART initiation, CD4+ growth rate was inversely correlated with baseline CD4+ T-cell counts, and consequently higher in adults than children. Our results highlight the impacts of age on dynamics of the immune system of healthy and HIV-infected individuals.

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Oral candida infection among HIV patients at Kilimanjaro Christian Medical Centre in northern, Tanzania

Tanzania Journal of Health Research ◽

10.4314/thrb.v18i1.8 ◽

2016 ◽

Vol 18 (1) ◽

Author(s):

Gwakisa Ngasala ◽

Maseke R. Mgabo ◽

John G. Mrema ◽

Janet Sabuni ◽

Steven Mwakalinga ◽

...

Keyword(s):

T Cell ◽

Oral Candidiasis ◽

Candida Infection ◽

Medical Centre ◽

Cd4 T Cell ◽

Hiv Patients ◽

Cell Counts ◽

Kilimanjaro Christian Medical Centre ◽

The Mean ◽

Oral Candida

Background: Oral candidiasis has been a global health challenge especially in immunocompromised patients particularly with HIV infection. Though the incidence and prevalence of opportunistic infections have been reduced due to the use of anti-retroviral therapy (ART), oral candidiasis remains the most frequently HIV-associated oral lesion in Tanzania. This study aimed at determining the prevalence of oral candida infection in HIV positive patients and investigate the relationship between oral manifestations and the level of immunosuppression. Method: This study was carried out at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. The study included 314 HIV patients with complete clinical results records who were diagnosed with HIV and who were on ARV and attending the hospital for care and treatment. Results: Prevalence of oral candida was 42.0% (132/314). Age group 6-27 years accounted for half of the infections (49/98). A significantly higher prevalence of candida infection (66.7%; 24/36) was obseved among patients with <200 cells/µl than in those with 200-500 cells/µl or >500 cells/µl (Chi-square χ2=14.9, p=0.001). The mean CD4+T-cell counts in HIV patients infected with oral candida was lower (523±35) than patients without oral candida infection (645±31 cells/µl), (ANOVA, p= 0.009). The mean CD4+ T-cell count among HIV patients on ART and those not on ART was not statistically different. Conclusion: The prevalence of oral candida infection was significantly higher in patients with CD4+ cell counts less than 200 cells/µl.

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The Factors Related to CD4+ T-Cell Recovery and Viral Suppression in Patients Who Have Low CD4+ T Cell Counts at the Initiation of HAART: A Retrospective Study of the National HIV Treatment Sub-Database of Zhejiang Province, China, 2014

PLoS ONE ◽

10.1371/journal.pone.0148915 ◽

2016 ◽

Vol 11 (2) ◽

pp. e0148915 ◽

Cited By ~ 6

Author(s):

Lin He ◽

Xiaohong Pan ◽

Zhihui Dou ◽

Peng Huang ◽

Xin Zhou ◽

...

Keyword(s):

Retrospective Study ◽

T Cell ◽

Viral Suppression ◽

Hiv Treatment ◽

Zhejiang Province ◽

Cd4 T Cell ◽

Cell Recovery ◽

Cell Counts

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Treatment cost of HIV/AIDS in Turkey

International Journal of Health Governance ◽

10.1108/ijhg-01-2020-0003 ◽

2020 ◽

Vol 25 (3) ◽

pp. 259-269

Author(s):

Hakan Özkaya ◽

Nehir Balcı ◽

Hülya Özkan Özdemir ◽

Tuna Demirdal ◽

Selma Tosun ◽

...

Keyword(s):

T Cell ◽

Treatment Cost ◽

Antiretroviral Treatment ◽

Cd4 T Cell ◽

Content Type ◽

Annual Treatment ◽

Cell Counts ◽

The Mean ◽

Annual Treatment Cost ◽

Hiv Aids

PurposeThe purpose of this study is to estimate the average cost of treatment and investigate the related parameters of HIV/AIDS among patients based on their annual treatment regime during the 2017 in Izmir.Design/methodology/approachThe average annual direct cost of an HIV patient's treatment was estimated for 2017 at four university hospitals in a retrospective study in Izmir, Turkey. Inclusion criteria included confirmed HIV infection, age = 18 years, visited one of the hospitals at least three times a year and with at least one CD4+ T cell count. The average annual treatment cost per patient was calculated using accounting data for 527 patients from the hospitals' electronic databases.FindingsThe mean treatment cost per patient was US$4,381.93. Costs for treatment and care were statistically significantly higher (US$5,970.55) for patients with CD4+ T cell counts of fewer than 200 cells/mm3 than for other patients with CD4+ T cell counts above 200 cells/mm3. The mean treatment cost for patients who were 50 years old or older (US$4,904.24) was statistically significantly higher than for those younger than 50 years (US$4,216.10). The mean treatment cost for female patients (US$4,624.92) was higher than that of male patients ($US4,339.72), although the difference was not statistically significant. The main cost driver was antiretroviral treatment (US$3,852.38 per patient), accounting for almost 88% of all costs. However, the high burden of antiretroviral treatment cost is counterbalanced by relatively low care and hospitalization costs in Turkey.Originality/valueThe paper contributes to the literature by providing average annual treatment cost of an HIV-infected patient in Turkey by using a comprehensive bottom up approach. Moreover, cost drivers of HIV treatment are investigated.

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Increased CD4 : CD8 ratio normalization with implementation of current ART management guidelines

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa484 ◽

2020 ◽

Author(s):

Alice Zhabokritsky ◽

Leah Szadkowski ◽

Curtis Cooper ◽

Mona Loutfy ◽

Alexander Wong ◽

...

Keyword(s):

T Cell ◽

Cell Count ◽

Proportional Hazards ◽

Treatment Guidelines ◽

Current Treatment ◽

Cd4 T Cell ◽

Cell Counts ◽

Living With Hiv ◽

Cd4 T Cell Count

Abstract Objectives To determine the time to CD4 : CD8 ratio normalization among Canadian adults living with HIV in the modern ART era. To identify characteristics associated with ratio normalization. Patients and methods Retrospective analysis of the Canadian Observational Cohort (CANOC), an interprovincial cohort of ART-naive adults living with HIV, recruited from 11 treatment centres across Canada. We studied participants initiating ART between 1 January 2011 and 31 December 2016 with baseline CD4 : CD8 ratio <1.0 and ≥2 follow-up measurements. Normalization was defined as two consecutive CD4 : CD8 ratios ≥1.0. Kaplan–Meier estimates and log-rank tests described time to normalization. Univariable and multivariable proportional hazards (PH) models identified factors associated with ratio normalization. Results Among 3218 participants, 909 (28%) normalized during a median 2.6 years of follow-up. Participants with higher baseline CD4+ T-cell count were more likely to achieve normalization; the probability of normalization by 5 years was 0.68 (95% CI 0.62–0.74) for those with baseline CD4+ T-cell count >500 cells/mm3 compared with 0.16 (95% CI 0.11–0.21) for those with ≤200 cells/mm3 (P < 0.0001). In a multivariable PH model, baseline CD4+ T-cell count was associated with a higher likelihood of achieving ratio normalization (adjusted HR = 1.5, 95% CI 1.5–1.6 per 100 cells/mm3, P < 0.0001). After adjusting for baseline characteristics, time-dependent ART class was not associated with ratio normalization. Conclusions Early ART initiation, at higher baseline CD4+ T-cell counts, has the greatest impact on CD4 : CD8 ratio normalization. Our study supports current treatment guidelines recommending immediate ART start, with no difference in ratio normalization observed based on ART class used.

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Validation of a Single-Platform, Volumetric, CD45-Assisted PanLeucogating Auto40 Flow Cytometer To Determine the Absolute Number and Percentages of CD4 T Cells in Resource-Constrained Settings Using Cameroonian Patients' Samples

Clinical and Vaccine Immunology ◽

10.1128/cvi.00023-12 ◽

2012 ◽

Vol 19 (4) ◽

pp. 609-615 ◽

Cited By ~ 10

Author(s):

François-Xavier Mbopi-Kéou ◽

Stefano Mion ◽

Bertrand Sagnia ◽

Laurent Bélec

Keyword(s):

T Cells ◽

T Cell ◽

Cd4 T Cells ◽

Flow Cytometer ◽

Cd4 T Cell ◽

Resource Constrained ◽

Limits Of Agreement ◽

Cell Counts ◽

Absolute Bias ◽

The Mean

ABSTRACTThe study evaluated the single-platform, volumetric, CD45-assisted PanLeucogating Auto40 flow cytometer (Apogee Flow Systems Ltd., Hemel Hempstead, United Kingdom) for CD4 T cell numeration, compared to the reference FACSCalibur flow cytometer. Results of absolute counts and percentages of CD4 T cells by Auto40 and FACSCalibur of 234 tripotassium EDTA (K3-EDTA)-blood samples from 146 adults and 88 children (aged from 18 months to 5 years), living in Yaoundé, Cameroon, were highly correlated (r2= 0.97 andr2= 0.98, respectively). The mean absolute bias and relative bias between Apogee Auto40 and FACSCalibur absolute CD4 T cell counts were +9.6 cells/μl, with limits of agreement from −251 to 270 cells/μl, and +4.1%, with limits of agreement from −16.1 to 24.4%, respectively. The mean absolute bias and relative bias between Apogee Auto40 and FACSCalibur CD4 T cell results expressed as percentages were +0.05% CD4 (95% confidence interval [CI], −0.03 to 0.41), with limits of agreement from −6.0 to 5.9% CD4, and +1.0%, with limits of agreement from −32.3 to 34.4%, respectively. The Auto40 counting allowed identification of the majority of adults with CD4 T cell counts below 200 cells/μl (sensitivity, 87%; specificity, 98%) or below 350 cells/μl (sensitivity, 92%; specificity, 98%) and of children with CD4 T cell counts below 750 cells/μl (sensitivity, 82%; specificity, 98%) or below 25% CD4+(sensitivity, 96%; specificity, 99%). The Auto40 analyzer is a reliable alternative flow cytometer for CD4 T lymphocyte enumeration to be used in routine immunological monitoring according to the WHO recommendations for HIV-infected adults as well as children living in resource-constrained settings.

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Faculty Opinions recommendation of Low nadir CD4+ T-cell counts predict gut dysbiosis in HIV-1 infection.

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

10.3410/f.733930398.793561280 ◽

2019 ◽

Author(s):

Alan Landay

Keyword(s):

T Cell ◽

Cd4 T Cell ◽

Gut Dysbiosis ◽

Cell Counts ◽

Hiv 1

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Lymphocyte subset analysis to evaluate the prognosis of HIV-negative patients with pneumocystis pneumonia

BMC Infectious Diseases ◽

10.1186/s12879-021-06124-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fan Jin ◽

Jing Xie ◽

Huan-ling Wang

Keyword(s):

T Cell ◽

Cell Count ◽

Lymphocyte Subsets ◽

Nk Cell ◽

Cd8 T Cell ◽

Pneumocystis Pneumonia ◽

Lymphocyte Subset ◽

Cd4 T Cell ◽

Cell Counts ◽

Hiv Negative

Abstract Objectives We analysed the peripheral blood lymphocyte subsets of human immunodeficiency virus (HIV)-negative patients infected with pneumocystis pneumonia (PCP) to determine the relationships between the levels of different types of lymphocytes and the prognosis of patients. Methods We retrospectively reviewed HIV-negative patients with PCP diagnosed in our department. All the eligible patients underwent lymphocyte subset analysis on admission. Results A total of 88 HIV-negative PCP patients were enrolled in the study. In univariate analyses, low CD4+ T cell count, low CD8+ T cell count, and low natural killer cell (NK cell) count were associated with higher in-hospital mortality. CD8+ T cell count ≤300/μL was found to be an independent risk factor for poor prognosis in multivariate logistical regression analysis (p = 0.015, OR = 11.526, 95% CI = 1.597–83.158). Although low CD4+ T cell and NK cell counts were not independent risk factors, the mortality rates of PCP patients decreased as the CD4+ T cell and NK cell counts increased. Conclusion The immune process of Pneumocystis jirovecii infection is complex but important. We propose that lymphocyte subsets could give clinicians a better understanding of patient immune status, helping with the early identification of potentially lethal infections and treatment decision making, such as adjusting the immunosuppressive regimen and choosing an appropriate patient monitoring level.

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