Staging and haematological abnormalities of HIV-infected persons in the rural Free State Province of South Africa

Objectives: The objectives of this study were firstly to determine HIV (human immunodeficiency virus) prevalence in the rural Free State, secondly to classify the stages of HIV by utilising CD4 (cluster of differentiation 4) counts, and thirdly to measure differences in haematological abnormalities between HIV-uninfected and HIV-infected participants. Method: Blood specimens were obtained from 552 participants in Springfontein (36.3%), Trompsburg (30.1%) and Philippolis (33.5%). Participants were between 25–64 years of age, of which 28.1% were male (mean age 47.3 years) and 71.9% were female (mean age 46.0 years). The primary screening for HIV status was performed using the Enzygnost® HIV Integral II Ag/Ab test and confirmed by the Vironostica® HIV Uni-Form II Ag/Ab test. Full blood counts were performed on all participants, but CD4 counts were only performed on HIV-positive serum.Results: The overall prevalence of HIV was 17.1%, with the peak prevalence in female participants (41.3%) occurring in the age group of 31–40 years, and in male participants (37.9%) in the age group of 41–50 years. Most HIV-uninfected participants (40.9%) were 51–60 years of age, whilst most HIV-infected participants were 31–40 years (35.6%) of age. The lowest mean CD4 count (276 cells/mm3) was observed in the age group 41–50 years, which was significantly lower than a mean count of 459 cells/mm3 in the age group 31–40 years (p ≤ 0.05). Haemoglobin was significantly reduced in HIV-infected male participants (p < 0.01) and female participants (p < 0.000 1), as ware white blood cell counts (p < 0.001), neutrofil counts (p < 0.005) and lymphocyte counts (p < 0.005). Peak prevalence of HIV in terms of age occurred later (between 31–40 years) than previously described and was reflected by a delayed low CD4 count (41–50 years).Conclusion: The low CD4 counts and anaemia were probably indicative of a generally ill study population. Participants in need of medical care should be identified and referred for management and follow-up.

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Staging and haematological abnormalities of HIV-infected persons in Mangaung in the Free State Province, South Africa

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v4i1.462 ◽

2012 ◽

Vol 4 (1) ◽

Cited By ~ 3

Author(s):

Andries J. Groenewald ◽

Corinna M. Walsh ◽

Hendrik J. Van Wyk ◽

Sanet Van Zyl ◽

Lynette J. Van der Merwe

Keyword(s):

South Africa ◽

Free State ◽

Haematological Parameters ◽

Hiv Status ◽

Cd4 Counts ◽

Cell Counts ◽

High Prevalence ◽

Significant Change ◽

White Blood Cell Counts ◽

Blood Specimens

Background: The prevalence of HIV in specific areas of South Africa and its impact on haematological parameters are largely unknown.Objectives: To (1) describe the prevalence of HIV, (2) stage HIV based on CD4 counts, and (3) determine haematological parameters amongst participants in Mangaung, Free State Province.Method: Blood specimens were obtained from 419 participants in formal and informal settlements in Mangaung. Participants were 25–64 years of age; 23.4% were male. Males and females were a mean of 45.1 and 44.3 years of age, respectively. Screening for HIV status was performed. Positive results were confirmed by a second test. Full blood counts were performed on all participants, and CD4 counts only on HIV-positive serum.Results: The overall prevalence of HIV was 40.8%. The highest prevalence occurred in the 31–40 years age group, with 38.4% of females and 39.5% of males being infected. More than 33% of HIV-uninfected participants were 51–60 years of age. No significant change in CD4 count with age was observed, probably because 19.1% of the 225 respondents who reported using medication were receiving antiretroviral (ARV) treatment. Haematological results showed that HIV-infected participants had significantly reduced values for haemoglobin, leukocytes, neutrophils and lymphocytes, compared to HIV-uninfected participants. The mean corpuscular volume (MCV) was significantly higher in HIV-infected participants.Conclusions: A high prevalence of HIV-infection was found. Anaemia and significantly reduced white blood cell counts were observed in the HIV-infected group. No significant change in CD4 counts with age was observed and could possibly be attributed to ARV therapy.

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Factors associated with the level of CD4 cell counts at HIV diagnosis in a French cohort: a quantile regression approach

International Journal of STD & AIDS ◽

10.1177/0956462416650980 ◽

2016 ◽

Vol 28 (4) ◽

pp. 397-403 ◽

Cited By ~ 1

Author(s):

Léa Bruneau ◽

Eric Billaud ◽

François Raffi ◽

Matthieu Hanf

Keyword(s):

Human Immunodeficiency Virus ◽

Quantile Regression ◽

Clinical Care ◽

Human Immunodeficiency Virus Patient ◽

Cd4 Count ◽

Heterosexual Transmission ◽

Cd4 Counts ◽

Factors Associated ◽

Cell Counts ◽

Immunodeficiency Virus

The consensus definition of late presentation for human immunodeficiency virus patient based on a CD4 threshold of 350 cells/mm3 has limitations concerning risk factors identification since there is growing biomedical justification for earlier initiation of treatment. The objective was to overcome this problem by simultaneously determining factors associated with different levels of CD4 counts at the time of diagnosis. Between January 2000 and July 2014, 1179 patients with a first human immunodeficiency virus diagnosis and entering care in a French human immunodeficiency virus reference center were enrolled. Factors associated with each 5 percentile from 5th to 95th quantile of CD4 counts at diagnosis were simultaneously studied in a multivariable quantile regression model. At each of the quantiles, the factors identified as negatively associated with CD4 count at diagnosis were older age, male sex , foreign patients, hepatitis B virus or hepatitis C virus co-infection, employment status, non-MSM transmission, heterosexual transmission, suburban and rural’s place of residence and earlier period of diagnosis. Association with CD4 count was not uniformly significant, most factors being significant for some quantiles. The only significant determinant for all quantiles was being born in a foreign country. These results are particularly helpful in the context of human immunodeficiency virus clinical care, management and prevention.

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Frequency of Cytomegalovirus Viral Load in Iranian Human Immunodeficiency Virus-1-Infected Patients with CD4+ Counts <100 Cells/mm3

Intervirology ◽

10.1159/000514385 ◽

2021 ◽

pp. 1-5

Author(s):

Mohammad Reza Jabbari ◽

Hoorieh Soleimanjahi ◽

Somayeh Shatizadeh Malekshahi ◽

Mohammad Gholami ◽

Leila Sadeghi ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Viral Load ◽

Cell Count ◽

Previous History ◽

Cd4 Count ◽

Cd4 Cell Count ◽

Cell Counts ◽

Immunodeficiency Virus ◽

Cd4 Cell ◽

Hiv 1

Objectives: The aim of present work was to assess cytomegalovirus (CMV) viremia in Iranian human immunodeficiency virus (HIV)-1-infected patients with a CD4+ count <100 cells/mm3 and to explore whether CMV DNA loads correlate with CD4+ cell counts or associated retinitis. Methods: This study was conducted at the AIDS research center in Iran on HIV-1-infected patients with CD4+ count <100 cells/mm3, antiretroviral therapy-naive, aged ≥18 years with no previous history of CMV end-organ disease (CMV-EOD). Results: Thirty-nine of 82 patients (47.56%) had detectable CMV viral load ranging from 66 to 485,500 IU/mL. CMV viral load in patients with retinitis ranges from 352 to 2,720 IU/mL, and it was undetectable in 2 patients. No significant associations between CMV viremia and CD4+ cell count was found (p value = 0.31), whereas significant association of CMV viremia in HIV-infected patients with retinitis was found (p < 0.02). Conclusions: We estimated the frequency of CMV viral load infection in Iranian HIV-1-infected patients with a CD4+ cell count <100 mm3/mL in the largest national referral center for HIV-1 infection in Iran. Further research is required on the relevance of CMV viral load in diagnostic and prognostic value of CMV-EOD.

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Effect of probiotic consumption on increasing the CD4+ T cell counts among Iranian patients living with HIV

Journal of Health Research ◽

10.1108/jhr-04-2019-0084 ◽

2019 ◽

Vol 34 (2) ◽

pp. 123-133

Author(s):

Hamid Emadi-Koochak ◽

Zeinab Siami ◽

Jayran zebardast ◽

SeyedAhmad SeyedAlinaghi ◽

Ali Asadollahi-Amin

Keyword(s):

Repeated Measures ◽

Antiretroviral Drugs ◽

Cd4 Count ◽

People Living With Hiv ◽

Content Type ◽

Cd4 Counts ◽

Cell Counts ◽

Significant Difference ◽

The Mean ◽

Living With Hiv

Purpose During the ART era, persistent immune activation remains a significant challenge in people living with HIV (PLWH). Microbial translocation play an essential role in this setting. Probiotics have several immunological benefits which can reverse this process. The purpose of this paper is to investigate the safety and efficacy of probiotics on CD4 counts among Iranian PLWH. Design/methodology/approach In total, 50 PLWH with CD4 counts above 350 cells/mm3 did not receive ART participated in a randomized, double-blind trial and underwent 24 weeks of treatment with either LactoCare® or placebo twice daily. CD4 counts of the patients were measured at baseline, 12 weeks and 24 later in the two groups. Side effects were measured monthly using a specific checklist. Findings The mean CD4 count of the patients showed a significant difference between the two groups after six months. Through six months follow up, the mean CD4 count of the patients showed a significant reduction as compared to the baseline in the placebo group; however, it did not show a significant difference in the probiotic group. Repeated Measures Anova test showed a significant effect for time × treatment interaction on the CD4 count during the trial course. No significant difference between the two groups concerning adverse events was reported. Originality/value It seems the use of probiotics in PLWH with a CD4 count above 350 cells/mm3 who are not receiving antiretroviral drugs is safe and can reduce the devastating process of CD4+ T cells in these patients.

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CD4 Variability in Malawi: Implications for Use of a CD4 Threshold of 500 Cells/mm3 Versus Universal Eligibility for Antiretroviral Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw180 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 1

Author(s):

Alan L. Schooley ◽

Pocha Samuel Kamudumuli ◽

Sitaram Vangala ◽

Chi-hong Tseng ◽

Chifundo Soko ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Geometric Mean ◽

Cost Savings ◽

Cd4 Count ◽

World Health ◽

Misclassification Rate ◽

Cd4 Counts ◽

Cell Counts ◽

Misclassification Rates ◽

Health Organization

Abstract Background. Given the uncertainty about the ability of a single CD4 count to accurately classify a patient as antiretroviral therapy (ART) eligible, we sought to understand the extent to which CD4 variability results in misclassification at a CD4 threshold of 500 cells/mm3. Methods. We performed a prospective study of CD4 variability in Malawian human immunodeficiency virus-infected, ART-naive, World Health Organization (WHO) stage 1 or 2, nonpregnant adults. CD4 counts were performed daily for 8 days. We fit a Bayesian linear mixed-effects model of log-transformed CD4 cell counts to the data. We used Monte Carlo approximations to estimate misclassification rates for different observed values of CD4. The misclassification rate was calculated based on the conditional probability of true CD4 given the geometric mean of observed CD4 measurements. Results. Fifty patients were enrolled from 2 sites. The median age was 33.5 years (interquartile range, 27.5–40.0) and 34 (68%) were female. Misclassification rates were <1% when the observed CD4 counts were ≤250 or ≥750 cells/mm3. Rates of misclassification were high at observed CD4 counts between 350 and 650 cells/mm3, particularly when a single measurement was used (up to 46.7%). Conclusions. Our data show that ART eligibility based on a single CD4 count results in highest risk of misclassification when observed CD4 counts are in the range of 350–650 cells/mm3. Given the benefits of early ART, countries should weigh the costs and complexity of CD4 testing using a 500 cell/mm3 threshold against the cost savings and public health benefits of universal eligibility.

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Cryptococcal Antigenemia in Nigerian Patients With Advanced Human Immunodeficiency Virus: Influence of Antiretroviral Therapy Adherence

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw055 ◽

2016 ◽

Vol 3 (2) ◽

Cited By ~ 9

Author(s):

Rita O. Oladele ◽

Alani S. Akanmu ◽

Augustina O. Nwosu ◽

Folasade T. Ogunsola ◽

Malcolm D. Richardson ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Tertiary Hospital ◽

Preemptive Therapy ◽

Early Screening ◽

Cd4 Cell Count ◽

Cd4 Counts ◽

Cell Counts ◽

Immunodeficiency Virus ◽

Cd4 Cell

Abstract Background. Cryptococcal meningitis has a high mortality in human immunodeficiency virus (HIV)-infected persons in Africa. This is preventable with early screening and preemptive therapy. We evaluated the prevalence of cryptococcal disease by antigen testing, possible associated factors, and outcomes in HIV-infected patients being managed in a tertiary hospital in Lagos, Nigeria. Methods. Sera were collected from 214 consenting HIV-infected participants with CD4+ counts <250 cells/mm3, irrespective of their antiretroviral therapy (ART) status, between November 2014 and May 2015. A cryptococcal antigen (CrAg) lateral flow assay was used for testing. Pertinent clinical data were obtained from patients and their case notes. Results. Of the 214 participants, females (124; 57.9%) outnumbered males. Mean age was 41.3 ± 9.4 (standard deviation) years. The majority (204; 95.3%) were ART experienced. The median CD4+ cell count was 160 cells/mm3 (interquartile range, 90–210). The overall seroprevalence of cryptococcal antigenemia was 8.9% (19 of 214); 6 of 61 (9.8%) in those with CD4+ cell counts <100 cells/mm3, 4 of 80 (5.0%) in the 100–200 group, and 9 of 73 (12.3%) in 200–250 cells/mm3 group. Among ART-naive patients, 1 of 10 (10%) was CrAg positive. Twenty-seven of 214 (12.6%) had associated oral thrush. Potential baseline meningitis symptoms (3 of 214 [1.4%] experienced neck pain or stiffness and 21 of 214 [9.8%] experienced headache) were common in the study group, but the result was not statistically significant in relation to CrAg positivity. Two of 19 (10.5%) CrAg-positive patients died, 10 of 19 (52.6%) were lost to follow up, and 7 of 19 (36.8%) were alive. Empirical fluconazole was routinely given to those with low CD4 counts <100 cells/mm3, which was unrelated to CrAg positivity (P = .018). Conclusions. We report a prevalence of 8.9% cryptococcal antigenemia in a setting where first-line antifungals are not readily available. We recommend CrAg screening for HIV-infected patients, even for patients on ART.

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Sonographic detection of abdominal pathologies in human immunodeficiency virus/acquired immunodeficiency syndrome patients and its correlation with CD4 counts – A prospective analysis

Indian Journal of Medical Sciences ◽

10.25259/ijms_393_2020 ◽

2020 ◽

Vol 0 ◽

pp. 1-8

Author(s):

Tejas Kanthrao Mankeshwar ◽

Ashok Kumar Sharma

Keyword(s):

Human Immunodeficiency Virus ◽

Lymph Nodes ◽

Acquired Immunodeficiency Syndrome ◽

Cd4 Count ◽

Aids Patients ◽

Cd4 Counts ◽

Immunodeficiency Virus ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Hiv Aids

Objectives: Abdominal pathologies are the second most common after pulmonary diseases in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. Ultrasonography (USG) is a vital imaging technique for the evaluation of abdominal pathologies. This study was aimed at evaluating the abdominal pathologies using USG in HIV/AIDS and further analysis of its correlation with CD4 count. Material and Methods: The present study was carried out on 392 HIV-positive patients with abnormal abdominal sonographic findings. All data were analyzed by Chi-square test and one-way analysis of variance using SPSS 16.0 software. Results: Of these 392 patients, 66.3% were males, the mean age was 35.7 years, (range 7–64 years) and most of them were in 4th decade. On ultrasonographic evaluation, spleen was involved in 45.2% patients and liver as well as lymph nodes each was involved in 43.6% patients. Other cases displayed ascites and bowel thickening in 5.3% and 3.8% patients, respectively. Less involvement of kidney (2.3%), pancreas (1.5%), and biliary system (1.3%) was observed. In addition, pathologies such as hepatomegaly, splenomegaly, splenic microabscess, focal pancreatic lesion, mesenteric, and periportal lymphadenopathy showed significant correlation with CD4 counts. Lymphoma was found in 1% of patients, involving liver, pancreas, and retroperitoneal lymph nodes. Conclusion: Our study highlights the clinical utility of abdominal USG in HIV/AIDS patients. CD4 counts largely affect the differential diagnosis in HIV/AIDS patients. USG findings interpreted in the context of CD4 count may help in guiding the exact diagnosis.

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Cluster of differentiation 4+ T-cell counts and human immunodeficiency virus-1 viral load in patients coinfected with hepatitis B virus and hepatitis C virus

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_37_17 ◽

2018 ◽

Vol 10 (02) ◽

pp. 162-167

Author(s):

Sakshee Gupta ◽

Bharti Malhotra ◽

Jitendra Kumar Tiwari ◽

Prabhu Dayal Khandelwal ◽

Rakesh Kumar Maheshwari

Keyword(s):

Viral Load ◽

T Cell ◽

Hepatitis B ◽

Cd4 T Cell ◽

Hiv Viral Load ◽

Cell Counts ◽

B Virus ◽

Immunodeficiency Virus ◽

Cluster Of Differentiation ◽

Hiv 1

ABSTRACT BACKGROUND: Coinfections of human immunodeficiency virus (HIV) with hepatitis viruses may affect the progress of disease and response to therapy. OBJECTIVES: To study the incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfections in HIV–positive patients and their influence on HIV–1 viral load and cluster of differentiation 4+ (CD4+) T–cell counts. MATERIALS AND METHODS: This pilot study was done on 179 HIV–positive patients attending antiretroviral therapy (ART) centre. Their blood samples were tested for HIV-1 viral load, CD4+ T–cell counts, hepatitis B surface antigen, anti–HCV antibodies, HBV DNA and HCV RNA polymerase chain reaction. RESULTS: Among the 179 patients, 7.82% (14/179) were coinfected with HBV and 4.46% (8/179) with HCV. Median CD4+ T–cell count of HIV monoinfected patients was 200 cells/µl and viral load was 1.67 log10 copies/µl. Median CD4+ T–cell counts of 193 cells/µl for HBV (P = 0.230) and 197 cells/µl for HCV (P = 0.610) coinfected patients were similar to that of HIV monoinfected patients. Viral load was higher in both HBV and HCV infected patients but statistically significant only for HCV (P = 0.017). Increase in CD4+ T–cell counts and decrease in HIV–1 viral load in coinfected patients on 2 years of ART were lower than that in HIV monoinfected patients. CONCLUSION: HBV/HCV coinfected HIV patients had similar CD4+ T–cell counts as in HIV monoinfected patients, higher HIV viral load both in chemo–naive patients and in those on ART as compared to HIV monoinfected patients. However, this study needs to be done on a large scale to assess the impact of coinfection on CD4 count and HIV viral load with proper follow–up of patients every 6 months till at least 2 years.

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Better Virological Outcomes Among People Living With Human Immunodeficiency Virus (HIV) Initiating Early Antiretroviral Treatment (CD4 Counts ≥500 Cells/µL) in the HIV Prevention Trials Network 071 (PopART) Trial in South Africa

Clinical Infectious Diseases ◽

10.1093/cid/ciz214 ◽

2019 ◽

Vol 70 (3) ◽

pp. 395-403 ◽

Cited By ~ 2

Author(s):

Geoffrey Fatti ◽

Ashraf Grimwood ◽

Jean B Nachega ◽

Jenna A Nelson ◽

Kelsea LaSorda ◽

...

Keyword(s):

South Africa ◽

Human Immunodeficiency Virus ◽

Hiv Prevention ◽

Cd4 Count ◽

Adjusted Relative Risk ◽

Cd4 Counts ◽

Immunodeficiency Virus ◽

Virological Outcomes ◽

Prevention Trials ◽

Cd4 Cell

Abstract Background There have been concerns about reduced adherence and human immunodeficiency virus (HIV) virological suppression (VS) among clinically well people initiating antiretroviral therapy (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HIV Prevention Trials Network 071 (PopART) trial in South Africa prior to routine national and international implementation. Methods This prospective cohort study included adults initiating ART at facilities providing universal ART since January 2014. VS (<400 copies/mL), confirmed virological failure (VF) (2 consecutive viral loads >1000 copies/mL), and viral rebound were compared between participants in strata of baseline CD4 cell count. Results The sample included 1901 participants. VS was ≥94% among participants with baseline CD4 count ≥500 cells/µL at all 6-month intervals to 30 months. The risk of an elevated viral load (≥400 copies/mL) was independently lower among participants with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with CD4 count 200–499 cells/µL (9.2%) between months 18 and 30 (adjusted relative risk, 0.30 [95% confidence interval, .12–.74]; P = .010). The incidence rate of VF was 7.0, 2.0, and 0.5 per 100 person-years among participants with baseline CD4 count <200, 200–499, and ≥500 cells/µL, respectively (P < .0001). VF was independently lower among participants with baseline CD4 count ≥500 cells/µL (adjusted hazard ratio [aHR], 0.23; P = .045) and 3-fold higher among those with baseline CD4 count <200 cells/µL (aHR, 3.49; P < .0001). Conclusions Despite previous concerns, participants initiating ART with CD4 counts ≥500 cells/µL had very good virological outcomes, being better than those with CD4 counts 200–499 cells/µL. Clinical Trials Registration NCT01900977.

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Quality of life factors affecting quality of life in people living with HIV/AIDS in an urban area

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20173367 ◽

2017 ◽

Vol 4 (8) ◽

pp. 3031 ◽

Cited By ~ 1

Author(s):

Pradnya S. Jadhav ◽

Payal S. Laad ◽

R. M. Chaturvedi

Keyword(s):

Quality Of Life ◽

Cd4 Count ◽

People Living With Hiv ◽

Age Group ◽

Factors Affecting ◽

Demographic Profile ◽

Study Population ◽

Living With Hiv ◽

Hiv Aids

Background: The aims and objectives were to study socio-demographic profile of people living with HIV/ AIDS; to assess quality of life of people living with HIV/AIDS (PLHA); to study factors affecting Quality of life (QOL) in people living with HIV/AIDS. Methods: A cross-sectional study was conducted which included 319 study subjects. Data on socio-demographic profile was collected using questionnaire and quality of life was assessed using WHO - brief questionnaire. Data was analysed using SPSS software and MS–Excel. Results: Majority of study population 52% were female & 40.8%belonged to 35-45 yrs age group. Out of 319 study subjects, 80.88% were literate and 19.1% were illiterates, 75.9% were married. 65.83% of the study subjects belonged to socio-economic class- II, 27.9% of the study subjects belong to class–I. Majority 52.98% study population had CD4 less than 300 and 47.02% had CD4 count more than 300 cells/mm3. Female have better QOl in comparison to male. Subjects >55 age group, illiterate, unemployed and CD4 count <300cells/mm3 have lower QOL (p<0.05) in comparison to their respective group. Conclusions: The most factors significantly associated with decreased quality of life of people living with HIV/AIDS in the present study include gender, literacy status, age group, employment status and CD4 count (p<0.05).

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