CD4 cell count recovery in HIV/TB co-infected patients versus TB uninfected HIV patients

Abstract Background: HIV infection has been associated with endothelial dysfunction. Endothelial microparticles (EMP) are informative markers of endothelial cell status and can exert transcellular effects in leukocytes. No previous studies have assessed EMP and their interactions with leukocytes in HIV-infected patients. Methods: We studied 29 patients (mean age = 42.1±7 years) with HIV infection on HAART who demonstrated an optimal viral and immunological response (CD4+ cell count>200 /mm3 and < 50 viral copies/ml by PCR analysis). Patients with diabetes, smoking, thrombotic, cardiovascular or malignant disease were excluded. We used age- and gender-matched healthy controls. Using flow cytometry, we measured free EMP identified by: Expression of CD31 and lack of expression of CD42b (EMP31); E-selectin expression (EMP62E); CD51 expression (EMP51), or; CD54 expression (EMP54). EMP62E- and EMP54-leukocyte conjugates were measured based on the detection of E-selectin or CD54, respectively, coexpressed with CD45 in neutrophils, monocytes and lymphocytes. Results: Results are summarized in Table 1. Levels of free EMP31, EMP51, EMP54 and EMP62E did not differ significantly between the groups. However, a very significant elevation of EMP54-Lymphocyte Conjugates (p=0.001) and a trend towards an elevation of EMP62E-Lymphocyte Conjugates was seen in HIV-infected patients. Furthermore, EMP63E-lymphocyte conjugates significantly correlated with the CD4+ cell count (R=-0.64; p=0.03). Conversely, HIV-infected patients demonstrated significantly lower levels of EMP62E -Monocyte Conjugates (p=0.0005) and a trend toward lower levels of EMP54 -Monocyte Conjugates (p=0.08). Conclusions: HIV infected patients with optimal response to HAART demonstrate an increased number of circulating EMP-lymphocyte conjugates with decreased number of EMP-monocyte conjugates. We speculate that viral EMP-receptor upregulation in lymphocytes and/or downregulation in monocytes could account for this phenomenon. EMP-lymphocyte conjugates inversely correlate with the CD4 count. The role of increased EMP-lymphocyte interactions in viral spread and lymphocyte dysfunction/apoptosis in HIV infected-patients requires further investigation. Levels of endothelial microparticles (EMPs) and EMP-leukocyte conjugates in HIV+ patients compared to controls. HIV+ Patients Control P value MFI=Mean fluorescence intensity EMP31, counts/μL (IQR) 680 (497–1112) 1018 (566-1691) 0.16 EMP51, counts/μL (IQR) 114 (75–141.5) 114 (96–143) 0.59 EMP62E, counts/μL (IQR) 72 (53.5–123.5) 77 (48–113) 0.66 EMP54, counts/μL (IQR) 58 (39.5–78.5) 39 (18–141) 0.42 EMP54-Lymphocyte Conjugates, MFI (IQR) 1.37 (1.26–1.42) 1.2 (1.13–1.26) 0.001 EMP54-Monocyte Conjugates, MFI (IQR) 1.14 (1.05–1.3) 1.22 (1.16–1.64) 0.08 EMP54-Neutrophil Conjugates, MFI (IQR) 1.46 (1.27–2.28) 1.66 (1.28–2.34) 0.74 EMP62E-Lymphocyte Conjugates, MFI (IQR) 1.15 (1.11–1.19) 1.13 (1.07–1.18) 0.13 EMP62E -Monocyte Conjugates, MFI (IQR) 1.17 (1.02–1.19) 1.31 (1.22–1.56) 0.0005 EMP62E -Neutrophil Conjugates, MFI (IQR) 1.47 (1.21–2.01) 1.94 (1.57–2.52) 0.10

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A superiority of viral load over CD4 cell count when predicting mortality in HIV patients on therapy

BMC Infectious Diseases ◽

10.1186/s12879-019-3781-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 10

Author(s):

Claris Shoko ◽

Delson Chikobvu

Keyword(s):

Viral Load ◽

Cell Count ◽

Hiv Patients ◽

Cd4 Cell Count ◽

Cd4 Cell

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Difference of Progression to AIDS According to CD4 Cell Count, Plasma HIV RNA Level and the Use of Antiretroviral Therapy among HIV Patients Infected through Blood Products in Japan

Journal of Epidemiology ◽

10.2188/jea.16.101 ◽

2006 ◽

Vol 16 (3) ◽

pp. 101-106 ◽

Cited By ~ 7

Author(s):

Miyuki Kawado ◽

Shuji Hashimoto ◽

Takuhiro Yamaguchi ◽

Shin-ichi Oka ◽

Kazuyuki Yoshizaki ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Cell Count ◽

Blood Products ◽

Hiv Patients ◽

Cd4 Cell Count ◽

Hiv Rna ◽

Cd4 Cell

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Joint Modeling in Detecting Predictors of Cd4 Cell Count and Status of Tuberculosis Among HIV Infected Patients Under HAART at Felege Hiwot Teaching and Specialized Hospital, North-west Ethiopia

10.21203/rs.3.rs-89429/v1 ◽

2020 ◽

Author(s):

Setegn Byabil Agegn ◽

Awoke seyoum Tegegn

Keyword(s):

Cell Count ◽

Joint Modeling ◽

Joint Analysis ◽

Joint Models ◽

Expected Number ◽

Hiv Patients ◽

Cd4 Cell Count ◽

North West ◽

Specialized Hospital ◽

Cd4 Cell

Abstract Background: Globally, the number of TB patients who had been diagnosed with HIV status reached 2.1 million, which is equivalent to 34 % of notified cases of TB. This research was conducted with the objective to identify potential predictors for the status of TB and CD4 cell count for adult HIV patients at Felege Hiwot Teaching and Specialized Hospital North-west Ethiopia.Methods: A retrospective repeated measures were taken from a sample of 226 HIV patients. Separate and joint models were conducted for data analysis of CD4 cell count and TB status of HIV infected patients. Results: The descriptive statistics indicates that among the HIV patients under HAART, 26.6% had additional TB cases. Hence, the expected number of CD4 cell count of HIV patients who were co-infected with TB was decreased by 2.34 as compared to HIV patients who were free from TB. In joint analysis, age, opportunistic infectious disease, adherence to medication, body mass index and social supports were significantly associated with CD4 cell count and TB status. In addition, one-way interaction terms (time * educational level) was also associated with both outcomes. As patients’ age increased by one year, the expected number of CD4 cell count was decreased by 0.025 cells per/mm3 keeping the other variables constant. The expected number of CD4 cell count for patients whose status were ambulatory was decreased by 3.95 as compared to working status. Both separate and joint modeling approach revealed consistent results for significant predictors. However, joint models were more adequate and efficient. Conclusions: Among the predictors of CD4 cell count and TB status, WHO stages, age of patients, functional status of patients, hemoglobin level and residence area were significant predictors for the variable of interests. More attention should be given for HIV/TB co- infected ambulatory and bedridden patients.

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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.

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Multiple sclerosis and HIV: a case of multiple sclerosis-immune reconstitution inflammatory syndrome associated with antiretroviral therapy initiation

International Journal of STD & AIDS ◽

10.1177/0956462418754972 ◽

2018 ◽

Vol 29 (9) ◽

pp. 929-932 ◽

Cited By ~ 5

Author(s):

Pria Anand ◽

Deanna Saylor

Keyword(s):

Multiple Sclerosis ◽

Antiretroviral Therapy ◽

Cell Count ◽

Immune Reconstitution ◽

Vision Loss ◽

Demyelinating Disease ◽

Immunosuppressive Drugs ◽

Hiv Patients ◽

Cd4 Cell Count ◽

Cd4 Cell

Studies have suggested that the incidence of multiple sclerosis (MS) in HIV-infected (HIV+) patients is lower than that of the general population. Here, we present a case of MS in an HIV+ patient with a relatively suppressed CD4 cell count who developed clinical and radiographic disease worsening in the setting of antiretroviral therapy (ART) initiation. A 47-year-old HIV+ woman (CD4 cell count 216 cells/µl) presented with decreased vision in her right eye. Magnetic resonance imaging (MRI) revealed optic nerve enhancement and open ring-enhancing lesions in the brain concerning for demyelinating disease. Cerebrospinal fluid was tested extensively for infection and malignancy with no abnormal findings. She received five days of intravenous methylprednisolone. Nine days later, she was restarted on ART. Three weeks later, she was readmitted with left eye vision loss and left hemiplegia (CD4 cell count 342 cells/µl). Repeat imaging showed multiple new enhancing lesions. Several cases have described severe MS relapses and unusually widespread demyelinating lesions on MRI after withdrawal of immunosuppressive drugs. We posit that the clinical and radiographic progression that occurred in our patient after initiation of ART represented an immune reconstitution response to ART. Caution may be warranted when initiating ART in HIV+ patients with suppressed CD4 cell count and active MS.

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