Low CD4
            <sup>+</sup>
            T-Lymphocyte Values in Human Immunodeficiency Virus-Negative Adults in Botswana

Bussmann, Hermann; Wester, C. William; Masupu, Kereng; Peter, Trevor; Gaolekwe, Sarah; Kim, Soyeon; Reich, Ann Marie; Ahn, Sam S.; Wu, Ying Jun; Thior, Ibou; Essex, Max; Marlink, Richard

doi:10.1128/cdli.11.5.930-935.2004

Cited by 35 publications

(41 citation statements)

References 42 publications

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“…The sensitivity of frequent testing and treatment to the CD4 + cell count at the start of treatment varies among countries in subSaharan Africa (Table 1). In Botswana, the mean CD4 + cell count among HIV-negative people is 666 cells/μL (20), it will have fallen to about 499 cells/μL by the end of the acute phase of HIV infection, and the difference between starting immediately and starting at a CD4 + cell count of 500 cells/μL is marginal. In South Africa, conversely, the mean CD4 + cell count among HIV-negative people in South Africa is 973 cells/μL (8), such that the CD4 + cell count is about 730 cells/μL by the end of the acute phase and only reaches 500 cells/μL after 3 y.…”

Section: Discussionmentioning

confidence: 99%

Antiretroviral therapy for tuberculosis control in nine African countries

Williams

Granich

Cock

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

120

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HIV has increased the incidence of tuberculosis (TB) by up to sevenfold in African countries, but antiretroviral therapy (ART) reduces the incidence of AIDS-related TB. We use a mathematical model to investigate the short-term and long-term impacts of ART on the incidence of TB, assuming that people are tested for HIV once a year, on average, and start ART at a fixed time after HIV seroconversion or at a fixed CD4 + cell count. We fit the model to trend data on HIV prevalence and TB incidence in nine countries in sub-Saharan Africa. If HIV-positive people start ART within 5 y of seroconversion, the incidence of AIDS-related TB in 2015 will be reduced by 48% (range: 37-55%). Long-term reductions depend sensitively on the delay to starting ART. If treatment is started 5, 2, or 1 y after HIV seroconversion, or as soon as people test positive, the incidence in 2050 will be reduced by 66% (range: 57-80%), 95% (range: 93-96%), 97.7% (range: 96.9-98.2%) and 98.4% (range: 97.8-98.9%), respectively. In the countries considered here, early ART could avert 0.71 ± 0.36 [95% confidence interval (CI)] million of 3.4 million cases of TB between 2010 and 2015 and 5.8 ± 2.9 (95% CI) million of 15 million cases between 2015 and 2050. As more countries provide ART at higher CD4 + cell counts, the impact on TB should be investigated to test the predictions of this model.Africa | HIV | test-and-treat

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Section: Discussionmentioning

confidence: 99%

Antiretroviral therapy for tuberculosis control in nine African countries

Williams

Granich

Cock

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

120

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“…In the Central African Republic, the mean CD4 value in non-pregnant females was 940cells/µl [3] a value which was higher, by 89 cells/µl, than that observed in our study of pregnant women. In Botswana mean CD4 T-lymphocyte counts (+/-SD) in HIV-seronegative non-pregnant females was 827(+/-245), [Bussmann et al, 2004]. Normal values for CD4 and CD8 T lymphocyte subsets in Shanghai was 727/540 cells / ul Jiang et al, 2004.…”

Section: Resultsmentioning

confidence: 99%

“…They are also used to monitor antiretroviral therapy (ART) [1,2,3,4,5]. Indeed the most recent WHO guidelines on HIV treatment recommend the use of CD4 counts to determine the need for combination antiretroviral therapy in HIVpositive patients, including pregnant women.…”

Section: Introductionmentioning

confidence: 99%

Reference Values of CD4-Lymphocyte Counts in HIV Seronegative Pregnant Women in Buea, Cameroon

Tanjong¹,

Atashili²,

Kamga³

et al. 2011

Af J Clin Exp Micro

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Pregnancy is a physiologically immunocompromised state, during which alterations in T-lymphocyte subsets may occur. Reference values for CD4 counts in pregnancy have not been established particularly in sub-Saharan populations. This study aimed at describing expected ('normal') values of CD4 counts in healthy HIV-negative pregnant women so these could serve as reference for assessing the progress of HIV disease in HIV-infected pregnant women. The study was conducted in antenatal clinics in the Buea Health District, Cameroon. All eligible women were interviewed using a standardized questionnaire. Whole blood samples collected were tested for HIV using Determine 1/2 and SD Bioline HIV-1/2 3.0 rapid tests. The CD4+ absolute counts were assessed using the Partec Cyflow Counter and the CD4 easy count kit. A total of 279 women were analysed. Their ages ranged from 15 to 47 years. A vast majority (95%) of participants were in the second or third trimester of gestation. Slightly less than half (43%) were primiparous. The CD4 cell count ranged from 321 to 1808 cells/µl . This distribution was approximately normal with a mean of 851cells/µl, a median of 831cells/µl , and a standard deviation of 254cells/µl . The expected ('normal') range, covering 95% of the sample was 438-1532 cells/µl. Participants with malaria parasitaemia tended to have a lower CD4 count (lower on average by 115 cells/µl, P<0.001). CD4 cell counts in HIV-negative pregnant women appear similar to those of the general population of HIV-negatives. These values can thus be used as references when assessing HIV-seropositive pregnant women.

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“…Some studies reported lower CD4 percent and absolute lymphocyte counts (29,30) in African cohorts compared to Caucasians, while others found similar (31) or relatively higher CD4þ T cell counts (32). Further, reference CD4þ T cell count values vary between Africans from different countries (29)(30)(31)33,34). Complicating this is the fact that most studies coupling CD4þ T cell count decline with opportunistic infections and mortality were done in industrialized countries, and the data has been extrapolated to guide clinical care in sub-Saharan Africa.…”

Section: Limitations Of Cd41 T Cell Enumerationmentioning

confidence: 99%

Clinical applications and availability of CD4+ T cell count testing in sub-Saharan Africa

Taiwo

Murphy

2008

Cytometry

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The absolute CD41 T cell count in adults and CD41 T cell percentage of lymphocytes (CD4%) in pediatrics compliment clinical history and physical examination to inform decisions about initiating antiretroviral therapy (ART). In addition, these immunologic markers predict host susceptibility to specific opportunistic infections, selected drug toxicities, and mortality. These benefits argue strongly for the availability of CD41 T cell testing capacity in all settings where HIV infection is treated. Several currently available flow cytometry-based devices, and novel CD41 T cell enumeration techniques such as the panleucogating CD4 are especially suitable for resource-constrained settings.At this time, unfortunately, the landscape of HIV care in sub-Saharan Africa is a mosaic characterized by large areas where CD41 T cell testing capacity is limited or unavailable, and small, but growing, pockets where the capacity exists. Routine HIV quantification is currently unaffordable and unsustainable in the great majority of the region; therefore, a reliance on CD41 T cell testing is inevitable for now. To this end, correcting the disparities in CD41 T cell testing capacity and defining the minimum laboratory requirements for the safe use of antiretroviral drugs through well-designed clinical studies are some of the most urgent priorities of the ongoing global scale-up of ART. q 2007 Clinical Cytometry Society

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Low CD4 ⁺ T-Lymphocyte Values in Human Immunodeficiency Virus-Negative Adults in Botswana

Cited by 35 publications

References 42 publications

Antiretroviral therapy for tuberculosis control in nine African countries

Antiretroviral therapy for tuberculosis control in nine African countries

Reference Values of CD4-Lymphocyte Counts in HIV Seronegative Pregnant Women in Buea, Cameroon

Clinical applications and availability of CD4+ T cell count testing in sub-Saharan Africa

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Low CD4 + T-Lymphocyte Values in Human Immunodeficiency Virus-Negative Adults in Botswana

Cited by 35 publications

References 42 publications

Antiretroviral therapy for tuberculosis control in nine African countries

Antiretroviral therapy for tuberculosis control in nine African countries

Reference Values of CD4-Lymphocyte Counts in HIV Seronegative Pregnant Women in Buea, Cameroon

Clinical applications and availability of CD4+ T cell count testing in sub-Saharan Africa

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Low CD4 ⁺ T-Lymphocyte Values in Human Immunodeficiency Virus-Negative Adults in Botswana