CD4+ T-Lymphopenia in HIV negative tuberculous patients at king khalid university hospital in riyadh, saudi arabia

Abstract

Tuberculosis (Tb) is a chronic infectious disease in which the cellular immunity (specifically CD4+ and CD8 lymphocytes) provides the most important defense in controlling infection. CD4 lymphopenia is a well-defined risk factor for the development of active tuberculosis in patients infected with Human Immunodeficiency Virus. In HIV - negative patients, CD4 and CD8 cell count suppression has been associated with Tb infection. Our study was designed to deter mine the baseline and post-treatment values of CD4 and CD8 in HIV negative patients diagnosed with active Tb in Saudi Arabian patients. We recruited twentyeight, non-HIV patients with tuberculosis for the study group comprising 16 males and 12 females with either disseminated or localized active Tb infection. Two control groups were selected - one of twenty one matched healthy controls and the second of fortytwo subjects from pool of controls of an ongoing study in same population for normal CD4 and CD8 counts. The baseline pre-treatment CD4 and CD8 counts in the study group were significantly lower than either control group. Specifically the mean ± SD of CD4 counts were 556.79 ± 298.81 in the study group vs 1,132.38 ± 259.90 in control group 1 and 1,424.38 ± 870.98 in control group 2 (p 0.000). Likewise the CD8 counts in the study group were 1,136.00 ± 512.06 vs. 1,461.90 ± 367.02 in control group 1 and 1,495.90 ± 565.32 in control group 2 (p 0.000) respectively. After treatment of tuberculosis, the study patients experienced a significant increase in their mean ± SD CD4 and CD8 cell counts, from 556.79 ± 297.81 to 954.29 ± 210.90 for CD4 cells (p 0.005) and 1136.00 ± 512.06 to 1,316.54 ± 286.17 for CD8 cells (p 0.002). Analysis of study patients with disseminated disease found significantly lower CD4 cells (but not lower CD8 cells) compared to study patients with localized disease, both at baseline and after treatment. The mean ± SD baseline CD4 cells were 247.60 ± 187.80 with disseminated vs 728.56 ± 186.32 for localized disease (p = 0.000) which rose to 842.30 ± 93.55 vs 1016.50 ± 233.51 (p = 0.033) respectively. We conclude that tuberculosis may be associated with CD4 and CD8 lymphopenia even in patients without human immunodeficiency virus infection, there was the tendency of recovery towards normality especially of the CD4 and CD8 counts after treatment, and that disseminated disease is associated specifically with profound CD4 lymphopenia.

Comparison of CD4 and CD8 counts and ratio in HIV negative pulmonary tuberculosis patients with normal healthy controls

“…This finding was similarly observed by Pilheu JA et al and Al-Aska AI et al, who reported mean of 259.33±100.89/mm 3 and 1136.00±512.06 versus 1461.90±367.02 respectively. 11,12 In another study by Shijubo et al, they observed significantly decreased CD8+ T cell which is similar to our finding. 16 This finding could be related to the fact that protective immunity against TB requires CD8+ T cells which are seen to accumulate at the site of mycobacterial infection, forming a cuff at the periphery of epitheloid cell granulomas.…”

Discordance in CD4+T-Cell Levels and Viral Loads with Co-Occurrence of Elevated Peripheral TNF-α and IL-4 in Newly Diagnosed HIV-TB Co-Infected Cases

“…1A). T-lymphopenia was not observed in TB patients under our study, unlike reported in some studies [11].…”

Idiopathic CD4 Lymphopenia

“…19,46 For both Sjögren syndrome 47,48 and sarcoidosis, CD4 lymphopenia has been associated with more severe disease and/or consequences. 57,58 Infections can be associated with decreased cell counts, including diminished CD4 lymphocyte counts, and this should not be confused with ICL. 50,51 Similar to many primary immunodeficiencies, malignancies have been reported in ICL, suggesting that the incidence is higher than in the average population.…”