Correlation of CD<sub>4</sub> counts with the FNAC patterns of tubercular lymphadenitis in patients with HIV: A cross sectional pilot study

Tuberculosis is one of the commonest opportunistic infection in HIV positive patients, especially in India. It can present in highly atypical manner hence high index of suspicion is essential to correctly diagnose and treat. Opportunistic infections have a definite correlation with CD4 counts in HIV positive patients. In India there are around 1.2 billion people, about half of them are adults in the sexually active age group. First case of AIDS was reported in 1986. The spread of HIV in India has been uneven. HIV epidemics are more severe in the southern half of the country and the far northeast. The highest estimated adult HIV prevalence is found in Manipur (0.78%), followed by Andhra Pradesh (0.76%), Karnataka (0.69%) and Nagaland (0.66%). However for the first time, in 2010 no states reported HIV prevalence among ANC attendees of 1.0%. Based on HIV Sentinel Surveillance 2008-09, it is estimated that 23.9 lakh people are infected with HIV in India, of whom 39% are female and 4.4% are children. The estimates highlight in ABSTRACT Background: HIV-AIDS is considered as a worldwide pandemic with an epicentre in Asia. Lymphadenopathy is the commonest manifestation observed in HIV-AIDS. Although multiple studies have been conducted in western countries, there is need for further studies to evaluate the causes of lymphadenopathy in Indian setting. So the FNAC study of HIV lymphadenopathy and its correlation with CD4 counts was carried out. Methods: Two yrs. observational study was carried out at the Tertiary care centre from Jan 2013 to Dec 2014. All the patients of HIV lymphadenopathy during this period were included in the study. History and clinical details were obtained from medical records. Thorough clinical examination was done in all cases. Thereafter Fine needle aspiration cytology (FNAC), both guided and unguided was performed, as needed. Smears were fixed and stained with H & E stain & special stains, as required. CD4 counts were carried out at the antiretroviral treatment (ART) centre. Results: Out of 64 cases, Tuberculosis (TB) lymphadenitis was the most common lesion with 47.05% cases & its mean CD4 count was 329/ul. There were 4 cases of malignancy; two were that of primary malignancy-lymphoma and other two were metastasis from epithelial malignancies. Conclusions: FNAC is a simple and rapid investigative technique to differentiate and diagnose various causes of lymphadenopathy. TB lymphadenitis is the most common lesion associated with HIV positive patients. CD4 counts correlate well with underlying lymph node pathology, TB lymphadenitis being common in CD4 range of 200-500/ul and HIV associated malignancies seen in CD4 count less than 100/ul.

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“…8,9 FNAC patterns may be used to predict the CD4 counts in HIV patients where CD 4 counting facilities are not available or vice versa. 10…”

Section: Discussionmentioning

confidence: 99%

Fine needle aspiration cytology study of HIV lymphadenopathy and its correlation with CD4 count

et al. 2015

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“…A number of studies provided evidence that the FNA is also a useful technique for immunophenotyping and the diagnosis of lymphadenopathy in HIV [2,7,8,28]. Most of these HIV studies focused on the cytological diagnostics of lymphadenopathies [10,13,16,18,20,[23][24][25][33][34][35]. In few cases, the LN-FNA was used as a tool to evaluate T-cell frequencies or lymphoid viral load [1,5,6,11,22].…”

Section: Introductionmentioning

confidence: 99%

Frequencies of lymphoid T‐follicular helper cells obtained longitudinally by lymph node fine‐needle aspiration correlate significantly with viral load in SIV‐infected rhesus monkeys

Klippert

Stolte-Leeb

Neumann

et al. 2015

J of Medical Primatology

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“…[ 14 15 16 ] FNAC being a minimally invasive, cost-effective, and rapid procedure, it was used as a diagnostic procedure to determine the cause of lymphadenopathy in these patients. [ 11 12 13 17 ]…”

Section: Discussionmentioning

confidence: 99%

Etiological study of lymphadenopathy in HIV-infected patients in a tertiary care hospital

Nag

Dey

Nandi

et al. 2016

J Cytol

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Introduction:Human immunodeficiency virus (HIV) infection has become a global pandemic. Persistent generalized lymphadenopathy (PGL) is very common manifestation of HIV infection. Moreover, different opportunistic infections such as tuberculosis (TB) and malignancies may present with lymphadenopathy. Mycobacterium avium complex (MAC) infection is most common with cluster of differentiation (CD)4+ count ≤50 cells/μL. Fine-needle aspiration cytology (FNAC) offers a simple and effective modality for obtaining a representative sample of the material from lymph nodes, permitting cytological evaluation and other investigations.Aims and Objectives:The aim of this study is to find out the different etiologies of lymphadenopathy in HIV-infected patients and to establish a possible correlation with CD4+ count.Materials and Methods:A total of 100 HIV-infected patients having significant (>1 cm) extrainguinal lymphadenopathy were studied in 1 year at the Department of Pathology by FNAC and the stains used were Leishman–Giemsa, Ziehl–Neelsen (ZN), Papanicoloau, and Gram stains. For tubercular culture, Löwenstein–Jensen (LJ) medium was used. CD4+count was done by flow cytometer.Result:The present study revealed four types of cytomorphological variants in lymphadenopathy cases by FNAC, which include: Reactive hyperplasia and caseation necrosis; caseation necrosis and ill-formed granuloma; well-formed granuloma without any necrosis; and non-Hodgkin lymphoma (NHL). The highest acid-fast bacilli (AFB) positivity was among the patients showing caseation necrosis. Tubercular culture in LJ media turned out as a more sensitive method for diagnosis than routine ZN staining. The 2 cases that showed well-formed epithelioid granuloma without any necrosis turned out to be histoplasmosis and cryptococcosis, respectively. In this study, we found 2 cases of NHL. The study also revealed that caseation necrosis and AFB positivity along with opportunistic infections increases with decreased CD4+ count.

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Correlation of CD₄ counts with the FNAC patterns of tubercular lymphadenitis in patients with HIV: A cross sectional pilot study

Cited by 13 publications

References 14 publications

Fine needle aspiration cytology study of HIV lymphadenopathy and its correlation with CD4 count

Fine needle aspiration cytology study of HIV lymphadenopathy and its correlation with CD4 count

Frequencies of lymphoid T‐follicular helper cells obtained longitudinally by lymph node fine‐needle aspiration correlate significantly with viral load in SIV‐infected rhesus monkeys

Etiological study of lymphadenopathy in HIV-infected patients in a tertiary care hospital

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Correlation of CD4 counts with the FNAC patterns of tubercular lymphadenitis in patients with HIV: A cross sectional pilot study

Cited by 13 publications

References 14 publications

Fine needle aspiration cytology study of HIV lymphadenopathy and its correlation with CD4 count

Fine needle aspiration cytology study of HIV lymphadenopathy and its correlation with CD4 count

Frequencies of lymphoid T‐follicular helper cells obtained longitudinally by lymph node fine‐needle aspiration correlate significantly with viral load in SIV‐infected rhesus monkeys

Etiological study of lymphadenopathy in HIV-infected patients in a tertiary care hospital

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Correlation of CD₄ counts with the FNAC patterns of tubercular lymphadenitis in patients with HIV: A cross sectional pilot study