T-lymphocyte subsets in acute illness

Feeney, Colin; Bryzman, Stephen; Kong, Li; Brazil, Harold; Deutsch, Robert; Fritz, Lawrence C.

doi:10.1097/00003246-199510000-00012

Cited by 38 publications

(22 citation statements)

References 17 publications

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“…This decrease of CD4 + /CD8 + T lymphocyte ratio was highly significant compared to acute cases (P = 0.038). This shows that low CD4 + T lymphocyte counts are associated with a variety of conditions in viral infections [35]. These findings were in corroboration with study carried out on patients with cervical intraepithelial neoplasia and invasive cancer revealed a decrease in CD4 cells with a relative increase in CD8 cell count, leading to a considerable reduction in the CD4/CD8 cell ratio [36].…”

Section: Discussionsupporting

confidence: 77%

Immunological and molecular epidemiological characteristics of acute and fulminant viral hepatitis A

Hussain

Husain

Almajhdi

et al. 2011

Virol J

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BackgroundHepatitis A virus is an infection of liver; it is hyperendemic in vast areas of the world including India. In most cases it causes an acute self limited illness but rarely fulminant. There is growing concern about change in pattern from asymptomatic childhood infection to an increased incidence of symptomatic disease in the adult population.ObjectiveIn-depth analysis of immunological, viral quantification and genotype of acute and fulminant hepatitis A virus.MethodsSerum samples obtained from 1009 cases of suspected acute viral hepatitis was employed for different biochemical and serological examination. RNA was extracted from blood serum, reverse transcribed into cDNA and amplified using nested PCR for viral quantification, sequencing and genotyping. Immunological cell count from freshly collected whole blood was carried out by fluorescence activated cell sorter.ResultsFulminant hepatitis A was mostly detected with other hepatic viruses. CD8+ T cells count increases in fulminant hepatitis to a significantly high level (P = 0.005) compared to normal healthy control. The immunological helper/suppressor (CD4+/CD8+) ratio of fulminant hepatitis was significantly lower compared to acute cases. The serologically positive patients were confirmed by RT-PCR and total of 72 (69.2%) were quantified and sequenced. The average quantitative viral load of fulminant cases was significantly higher (P < 0.05). There was similar genotypic distribution in both acute and fulminant category, with predominance of genotype IIIA (70%) compared to IA (30%).ConclusionsImmunological factors in combination with viral load defines the severity of the fulminant hepatitis A. Phylogenetic analysis of acute and fulminant hepatitis A confirmed genotypes IIIA as predominant against IA with no preference of disease severity.

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Section: Discussionsupporting

confidence: 77%

Immunological and molecular epidemiological characteristics of acute and fulminant viral hepatitis A

Hussain

Husain

Almajhdi

et al. 2011

Virol J

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“…41 percent had CD4 levels below 400, and 29 percent were below 300. The CD4/CD8 ratio, thought to be a marker of HIV infection, was less than one in 16 percent [16]. Secondly, individuals have been identified with low levels of CD4 without HIV infection, both associated with opportunistic infections and also when asymptomatic [17]–[19].…”

Section: Discussionmentioning

confidence: 99%

False Positive HIV Diagnoses in Resource Limited Settings: Operational Lessons Learned for HIV Programmes

2013

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BackgroundAccess to HIV diagnosis is life-saving; however the use of rapid diagnostic tests in combination is vulnerable to wrongly diagnosing HIV infection when both screening tests give a false positive result. Misclassification of HIV patients can also occur due to poor quality control, administrative errors and lack of supervision and training of staff. Médecins Sans Frontières discovered in 2004 that HIV negative individuals were enrolled in some HIV programmes. This paper describes the result of an audit of three sites to review testing practices, implement improved testing algorithms and offer re-testing to clients enrolled in the HIV clinic.FindingsIn the Democratic Republic of Congo (DRC), Burundi and Ethiopia patients were identified for HIV retesting. In total, 44 false-positive patients were identified in HIV programmes in DRC, two in Burundi and seven in Ethiopia. Some of those identified had been abandoned by partners or started on anti-retroviral therapy or prophylaxis. Despite potential damage to programme reputations, no impact in terms of testing uptake occurred with mean monthly testing volumes stable after introduction of re-testing. In order to prevent the problem, training, supervision and quality control of testing procedures were strengthened. A simple and feasible confirmation test was added to the test algorithm. Prevalence of false positives after introducing the changes varied from zero percent (95% CI 0%–8.2%) to 10.3 percent (95% CI: 7.2%–14.1%) in Burundi and DRC respectively.ConclusionFalse HIV diagnoses were found in a variety of programme settings and had devastating individual consequences. We re-tested individuals in our programmes while instituting improved testing procedures without a negative impact on test uptake. Considering the importance of correct diagnosis to the individual, as well as the resources needed to care for someone with HIV, it is critical to ensure that all patients registered in HIV programmes are accurately diagnosed.

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“…Because there are various non-HIV-related causes of CD4 decline such as acute illness or CD4-lowering treatments like trimethoprim-sulfamethoxazole, chemotherapy or interferon. 8,24 Physiologic variation can also lead to a transient CD4 decline. One study reported physiologic CD4 variation around a median of 119 cells/μL ranged from 35 to 395 cells/μL over 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Operational Research

Ahn

Boettiger²,

Law

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Current treatment guidelines for HIV infection recommend routine CD4+ lymphocyte (CD4) count monitoring in patients with viral suppression. This may have a limited impact on influencing care as clinically meaningful CD4 decline rarely occurs during viral suppression. Methods In a regional HIV observational cohort in the Asia-Pacific, patients with viral suppression (2 consecutive viral loads <400 copies/mL) and a CD4 count ≥200 cells/μL who had CD4 testing 6 monthly were analyzed. Main study endpoints were occurrence of one CD4 count <200 cells/μL (single CD4<200) and two CD4 counts <200 cells/μL within a 6-month period (confirmed CD4<200). A comparison of time to single and confirmed CD4<200 with biannual or annual CD4 assessment was performed by generating a hypothetical group comprised of the same patients with annual CD4 testing by removing every second CD4 count. Results Among 1538 patients, the rate of single CD4<200 was 3.45/100 patient-years, and of confirmed CD4<200 was 0.77/100 patient-years. During 5 years of viral suppression, patients with baseline CD4 200-249 cells/μL were significantly more likely to experience confirmed CD4<200 compared with patients with higher baseline CD4 (hazard ratio 55.47 [95% confidence interval 7.36–418.20], p<0.001 versus baseline CD4 ≥500 cells/μL). Cumulative probabilities of confirmed CD4<200 was also higher in patients with baseline CD4 200-249 cells/μL compared with patients with higher baseline CD4. There was no significant difference in time to confirmed CD4<200 between biannual and annual CD4 measurement (p=0.336). Conclusions Annual CD4 monitoring in virally suppressed HIV patients with a baseline CD4 ≥250 cells/μL may be sufficient for clinical management.

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T-lymphocyte subsets in acute illness

Cited by 38 publications

References 17 publications

Immunological and molecular epidemiological characteristics of acute and fulminant viral hepatitis A

Immunological and molecular epidemiological characteristics of acute and fulminant viral hepatitis A

False Positive HIV Diagnoses in Resource Limited Settings: Operational Lessons Learned for HIV Programmes

Implementation and Operational Research

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