Distribution of CD4+ T Lymphocytes at Diagnosis of Acquired Immunodeficiency Syndrome—Defining and Other Human Immunodeficiency Virus—Related Illnesses

Hanson, Debra L.; Chu, Susan Y.; Farizo, Karen M.; Ward, John W.

doi:10.1001/archinte.1995.00430140115012

Cited by 81 publications

(15 citation statements)

References 29 publications

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“…[15][16][17] A severity order of HIV-related signs based on CD4 lymphocyte counts at which they occur has been suggested from studies in developed countries. 18,19 HIV disease progression is known to be similar for patients in Africa and in developed countries. [23][24][25] In Uganda, HIV-infected patients had less than 3.5 months of the median survival and less than 200 CD4 count around the time of developing Kaposi's sarcoma, esophageal candidiasis, and wasting syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Rationale behind the classification was based on many studies showing that HIV-infected persons present many clinical signs as the disease progresses [15][16][17] and there is a strong association between HIV-related signs and CD4 lymphocyte counts at which they occur. 18,19 The primary outcome was extended to combine the AIDS progression and death, whichever came first. For the AIDS progression outcome, individual failure times were defined as the period between enrollment in the study and the incidence date of the AIDS progression or censoring.…”

Section: Study Outcomesmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Tuberculosis Preventive Therapy on HIV Disease Progression and Survival in HIV-Infected Adults

Lim

Okwera²,

Mayanja‐Kizza

et al. 2006

HIV Clinical Trials

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Purpose: To determine whether tuberculosis (TB) preventive therapies alter the rate of disease progression to AIDS or death and to identify significant prognostic factors for HIV disease progression to AIDS. Method:In a randomized placebo-controlled trial in Kampala, Uganda, 2,736 purified protein derivative (PPD)-positive and anergic HIV-infected adults were randomly assigned to four and two regimens, respectively. PPD-positive patients were treated with isoniazid (INH) for 6 months (6H; n = 536), INH plus rifampicin for 3 months (3HR; n = 556), INH plus rifampicin plus pyrazinamide for 3 months (3HRZ; n = 462), or placebo for 6 months (n = 464). Anergic participants were treated with 6H (n = 395) or placebo (n = 323).Results: During follow-up, 404 cases progressed to AIDS and 577 deaths occurred. The cumulative incidence of the AIDS progression was greater in the anergic cohort compared to the PPD-positive cohort (p < .0001). Among PPD-positive patients, the relative risk of the AIDS progression with INH alone was 0.95 (95% CI 0.68-1.32); with 3HR it was 0.83 (95% CI 0.59-1.17); and with 3HRZ it was 0.76 (95% CI 0.52-1.08), controlling for significant baseline predictors. Among anergic patients, the relative risk of the AIDS progression was 0.81 (95% CI 0.56-1.15). Survival was greater in the PPD-positive cohort compared to the anergic cohort (p = . 0001). Conclusion:The number of signs or symptoms at baseline and anergic status are associated with increasing morbidity and mortality. Even though the tuberculosis preventive therapies were effective in reducing the incidence of TB for HIV-infected adults, their benefit of delaying HIV disease progression to AIDS was not observed. There is now the promise for greater access to antiretroviral medications. These medications must be properly used to maximize benefit and minimize untoward, adverse effects. Although recommendations have been developed and the availability of new antiretroviral drugs has expanded treatment choices, 7 this does not take into account the technology void in many developing countries. To make informed decisions about when to start treatment, what therapy to start with, and how to monitor the response to treatment, health care practitioners need more details about the natural history of HIV infection. Few studies have addressed disease progression in sub-Saharan Africa, where over 65% of the world's 39.4 million infected adults and children live. 7 In Uganda, the prevalence of HIV infection in adults is estimated at 8% in rural areas and up to 40% in some rural areas and trading centers. 8,9 The cumulative progression to AIDS at 1, 3, and 5 years after seroconversion is 2%, 6%, and 22%, respectively. The median survival time after the onset of AIDS is 9.3 months. 10 Although the recent declines in morbidity and mortality due to HIV/AIDS are attributable to the use of more intensive antiretroviral therapies, 3,4 the availability of antiretroviral drugs is limited in developing countries. Even as the antiretroviral therapy rolls out i...

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Section: Discussionmentioning

confidence: 99%

Section: Study Outcomesmentioning

confidence: 99%

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Effect of Tuberculosis Preventive Therapy on HIV Disease Progression and Survival in HIV-Infected Adults

Lim

Okwera²,

Mayanja‐Kizza

et al. 2006

HIV Clinical Trials

View full text Add to dashboard Cite

show abstract

“…Tuberculosis, unlike other HIV-associated opportunistic infections, may also occur at relatively high levels of CD4 lymphocytes count [23], although its frequency markedly increases in patients with more severe immunosuppression [24]. It is possible that among HAART-treated patients, although the risk of developing tuberculosis is greatly reduced, the relative proportion of patients with higher CD4 lymphocytes increases, resulting in a relative increase of tuberculosis cases among patients who are less immunosuppressed and thus in an increase in the median CD4 lymphocytes count at the time of diagnosis of tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in HIV‐infected persons in the context of wide availability of highly active antiretroviral therapy

et al. 2004

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Highly active antiretroviral therapy (HAART) greatly reduces the risk of developing tuberculosis for HIV‐infected persons. Nonetheless, HIV‐associated tuberculosis continues to occur in countries where HAART is widely used.To identify the characteristics of HIV‐infected persons who develop tuberculosis in the context of the availability of HAART, the current authors analysed data taken from 271 patients diagnosed, in Italy, during 1999–2000. These patients represent 0.7% of the 40,413 HIV‐infected patients cared for in the clinical units participating in this current study.From the data it was observed that 20 patients (7.4%) had a previous episode of tuberculosis whose treatment was not completed. Eighty-one patients (29.9%) were diagnosed with HIV at tuberculosis diagnosis, 108 (39.8%) were aware of their HIV status but were not on antiretroviral treatment and 82 (30.3%) were on antiretroviral treatment. Patients on antiretroviral treatment were significantly less immunosuppressed than patients with HIV diagnosed concurrently with tuberculosis, or other patients not on antiretrovirals (median CD4 lymphocytes count: 220 cells·mm−3versus100 cells·mm−3, and 109 cells·mm−3, respectively). No significant differences in clinical presentation of tuberculosis according to antiretroviral therapy status were recorded.Failure of tuberculosis control interventions (e.g.noncompletion of treatment) and of HIV care (delayed diagnosis of HIV infection and suboptimal uptake of therapy) may contribute to continuing occurrence of HIV‐associated tuberculosis in a country where highly active antiretroviral therapy is largely available. However, a significant proportion of cases occur in patients who are on antiretroviral treatment.

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“…Imaging examinations should always be interpreted with a knowledge of how symptomatic the patient is, the degree of dyspnoea, the level of impairment of the carbon monoxide diffusing capacity of the lung (DL,CO), the CD4z cell count, the presence of fever or leukocytosis, if there is a cough and whether the cough is productive, and the chronicity of symptoms [8]. Knowledge of whether the patient has developed a CAP or NP, as well as knowledge of the immune status of the patient, can be powerful tools in arriving at a shortlist of possible causative organisms [8,9]. Clinical information can greatly enhance the accuracy of the radiographical diagnosis, i.e.…”

Section: Integrating Clinical and Imaging Findingsmentioning

confidence: 99%

Imaging of pneumonia: trends and algorithms

2001

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Pneumonia is one of the major infectious diseases responsible for significant morbidity and mortality throughout the world. Imaging plays a crucial role in the detection and management of patients with pneumonia. This review article discusses the different imaging methods used in the diagnosis and management of suspected pulmonary infections. The imaging examination should always begin with conventional radiography. When the results of routine radiography are inconclusive, computed tomography is mandatory. A combination of pattern recognition with knowledge of the clinical setting is the best approach to the pulmonary infectious processes.A specific pattern of involvement can suggest a likely diagnosis in many instances. In acquired immune deficiency syndrome patients, diffuse ground-glass and interstitial infiltrates are most commonly present in Pneumocystis carinii pneumonia whereas in the nonimmunosuppressed patients, a segmental lobar infiltrate is suggestive of a bacterial pneumonia. Round pneumonia is most often encountered in children than adults and is most often caused by Streptococcus pneumoniae. Different combinations of parenchymal and pleural abnormalities may be suggestive for additional diagnoses.When an infectious pulmonary process is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures, and serving as an ideal tool for follow-up examinations.

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Distribution of CD4+ T Lymphocytes at Diagnosis of Acquired Immunodeficiency Syndrome—Defining and Other Human Immunodeficiency Virus—Related Illnesses

Abstract: Our observations support the need for continued CD4+ cell count monitoring below a level of 0.20 x 10(9)/L as a guide to diagnosis and medical management of HIV-infected persons.

Cited by 81 publications

References 29 publications

Effect of Tuberculosis Preventive Therapy on HIV Disease Progression and Survival in HIV-Infected Adults

Effect of Tuberculosis Preventive Therapy on HIV Disease Progression and Survival in HIV-Infected Adults

Tuberculosis in HIV‐infected persons in the context of wide availability of highly active antiretroviral therapy

Imaging of pneumonia: trends and algorithms

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