Relationship between C-reactive protein, ferritin serum and cluster of differentiation 4 cell count with pulmonary tuberculosis in naive HIV patient in Bali

Background:Diagnostic of Pulmonary tuberculosis (PTB) in patients with Human immunodeficiency virus (HIV) infection remain challenging. Evaluation based on clinical symptoms, inflammation biomarkers, and immunodeficiency status, can provide a feature of PTB disease in HIV patient. The aim of thestudy was to analyze the relationship between acute phase reactant and immunodeficiency status with PTB in patients with na飗e HIV infection.Methods:A cross sectional study was conducted in Sanglah General Hospital and Kuta Selatan Public Health Service on February-June 2021. C-reactive protein (CRP), Ferritin serum levels, and CD-4 cell count were obtained from patient's serum. Data were collected by questionnaire. Bivariate analysis using Chi square test or Kolmogorov Smirnovtest, and multivariate analysis using logistic regression.Results:A total of 60 participants were included in this study, and 58.3% had pulmonary tuberculosis (38.3% bacteriologically confirmed, 20% clinically confirmed). Fifty five percent participants had CRP level ?10 mg/l, 83% had ferritin serum level ?260ng/ml, and 83% had CD4 cell count<200 cell/ml. Multivariate analysis showed that the most influential factor for PTB in HIV patients was CRP level?10 mg/l (adjusted prevalence ratio/APR=4.9; 95%CI=7.81-2327,04,p=0.001) and ferritin serum level ?260 ng/ml(APR=3.32,95%CI=1.752-433.65,p=0.018).Conclusions:High CRP and ferritin serum levels were significantly related with PTB in naive HIV patients. No relationship was found between low CD4 cell count and PTB in naive HIV patients

Pattern of Maternal Group B Streptococcus (GBS) Colonization in Relation to CD4 Count among HIV Positive Women in Jos

Aim: The aim of this study was to determine the prevalence of GBS colonization among HIV positive and HIV negative pregnant women in relation to CD4 cell counts.Materials and Methodology: This was a hospital based descriptive cross-sectional study of 200 pregnant women (100 HIV positive and 100 HIV negative) and 100non-pregnant women (50 HIVpositive and 50 HIV negative) obtaining health care at the Jos University Teaching Hospital betweenJuly 2017 and November 2017. Systematic sampling technique and written informed consent were used in recruiting subjects for this study. High vaginal and anorectal swabs were collected from each subject after filling a structured questionnaire. CD4 cell count was also done for all the HIV positive patients at Aids Prevention Initiative in Nigeria (APIN) of Jos University Teaching Hospital (JUTH). The results from the laboratory analysis of the specimens were computed using SPSS version 21.Results: A colonization rate of 7.3% was observed in HIV positive patients compare to 5.3% in HIV negative. The different in colonization rate between the two groups was not statistically significant (X2 = 0.507; P = 0.477) (Table 1). In pregnant women living with HIV, colonization rate was 8.0% compare to 5.0% observed in non-pregnant women living with HIV. This however, was not statistically significant (Table 2) (χ2 = 0.013; P = 0.908). HIV positive subjects with low CD4 counts (<200cells/μl) were observed to have highcolonization rate (20.0%) than patients with high CD4 counts (≥500 cells/μl). Those with CD4 counts between 200-499 cells/μl had 8.1% colonization rate. These findings, though not statistically significant (Table 4) (χ2 = 1.3814; P = 0.2399), the increased colonization rate in low CD4 cell counts may be due to inability of the patient to mount immune response against the organism.Conclusion: There was no statistically significant difference in GBS colonization among HIV positive patients. A higher colonization rate was observed in HIV patients among the age group 21-25 years; ager was not significantly risk factor for GBS colonization in HIV patients. CD4 cell counts seem not to play any significant role in GBS colonization rate. Although, it was observed to be higher in patients with low CD4 cell counts; the different was not statistically significant

Assessment of Antiphospholipid Antibodies, CD4 Count and Some Haematological Parameters in HIV Patients attending a Tertiary Health Institution in South-Western Nigeria

Background: Antiphospholipid antibodies (aPLs) are the serological markers used in the diagnosis of the antiphospholipid syndrome (APS). HIV infection has been associated with an elevated aPls level, but its link to the APS with clinical thrombosis is still been investigated. This study is designed to determine and correlate serum level of antiphospholipid antibodies with CD4 count and some haematological parameters of HIV seropositive subjects in comparison to those of healthy controls and also to compare these parameters between antiretroviral therapy (ART) naïve and treated patients. Methodology: A cohort of 110 patients which consist of 90 HIV positive Patients (22 males and 68 females) and 20 HIV negative patients (10 males and 10 females) which serve as control attending Babcock University Teaching Hospital (BUTH) Ilishan-Remo, Ogun State, Nigeria were recruited for the cross-sectional study. HIV antibodies were detected using 3 rapid diagnostic kits (Determine, Unigold and Stat Pak). CD4+ cells were counted using Partec® Cyflow Counter (Germany). The Full Blood Count was analyzed using the Sysmex® Automated Haematology Analyzer (Kobe-Japan). Antiphospholipid antibodies (aPLs) were assayed using the Human Anti-Phospholipid Screen IgG/IgM ELISA kit (Alpha Diagnostic International, Texas, USA). Results: The present study showed that the mean serum antiphospholipid antibody level was significantly (P<0.001) higher in HIV positive Patients (11.83±7.36u/ml) compared to the control group (7.30±3.95u/ml). While on one hand, there was a strong positive correlation between serum aPLs level and PLT (r= 0.044), MCHC (r= 0.084) and LYM (r= 0.105) in HIV infection; on the other hand, there was a strong negative correlation with CD4 count (r= -0.094), PCV (r= -0.099), Hb (r= -0.072), RBC (r= -0.003), WBC (r= -0.063), MNO (r= -0.213), GRA (r= -0.003), MCV (r= -0.023) and MCH (r= -0.005). Also, there was no significant differences (P>0.05) between the aPLs level of HIV group on ART (11.44±7.74 u/ml) and those not on ART (12.00±7.24 u/ml). Some haematological parameters like PLT, PCV, Hb, RBC and red cell indices of the HIV group on ART did not differ significantly from those not on ART. However, the CD4 count (638.89±119.56 cell/?L), WBC (5.38±1.49X103/?L), LYM (51.43±7.99%) and GRA (46.30±10.18%) of the HIV group on ART were significant higher than those not on ART (465.30±145.92 cell/?L, 4.55±1.57X103/?L, 42.23±10.96% and 39.10±7.81%, respectively). Conclusion: Significant elevated aPLs level is present in HIV infection; however, the information obtained is not sufficient to indicate the occurrence of anti-phospholipid syndrome in HIV infection. There was no strong relationship between aPLs level and indicators of immunohaematological abnormalities in HIV infection. This finding is plausible and would therefore require further investigation.

The Usefulness of Hematological Parameters for Assessing Disease Progression in Patients with HIV Infection

BACKGROUND: In patients with HIV, CD4+ T cell count and viral load are the main laboratory tests performed to assess clinical management. However, they require extensive resources. In this study, we aimed to determine whether hematological parameters measured using a hematology analyzer are useful as surrogate markers of CD4+ T cell count and viral load in HIV-infected patients. METHODS: Peripheral blood samples were obtained from 14 HIV-naïve, 105 HIV-treated, and 103 uninfected individuals. Hematological parameters were measured using the ADVIA 2120i hematology analyzer (Siemens Healthcare Diagnostics, USA). RESULTS: In HIV-naïve and -treated patients, the percentage of large unstained cells (%LUCs) was 2.5±1.6% and 1.9±0.7%, respectively, compared to 1.6±0.5% in HIV-uninfected controls. The %LUCs was higher in HIV patients with low CD4⁺ T cell count below 200/μL (2.4±1.0%) or high viral load ≥200 copies/mL (2.4±0.8%) than in other infected groups. Significant differences in lymphocyte count were observed between the HIV-naïve (1.5±0.6×10⁹/L) and uninfected (2.0±0.6×10⁹/L) groups as well as between HIV patients with CD4⁺ T cells ≥500/μL (2.5±0.6×10⁹/L) and other infected groups. Neutrophil count varied between high viral load (3.0±1.4×10⁹/L) and low viral load (3.7±1.3×10⁹/L) groups. The CD4⁺ T cell count correlated with lymphocyte count (r=0.642, P<0.0001) and %LUCs (r=-0.287, P=0.002). CONCLUSIONS: %LUCs, lymphocyte count, and neutrophil count are probable surrogate markers of CD4⁺ T cells and viral load.

Multiple facets of HIV-associated renal disease

HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.

Evaluation of late presentation for HIV treatment in a reference center in Belo Horizonte, Southeastern Brazil, from 2008 to 2010

Introduction: Since 1996 Brazil has provided universal access to free antiretroviral therapy, and as a consequence, HIV/AIDS patients' survival rate has improved dramatically. However, according to scientific reports, a significant number of patients are still late presenting for HIV treatment, which leads to consequences both for the individual and society. Clinical and immunological characteristics of HIV patients newly diagnosed were accessed and factors associated with late presentation for treatment were evaluated. Methods: A cross-sectional study was carried out in an HIV/AIDS reference center in Belo Horizonte, Minas Gerais, in Southeastern Brazil from 2008 to 2010. Operationally, patients with late presentation (LP) for treatment were those whose first CD4 cell count was less than 350 cells/mm3 or presented an AIDS defining opportunistic infection. Patients with late presentation with advanced disease (LPAD) were those whose first CD4 cell count was less than 200 cells/mm3 or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods. Results: Five hundred and twenty patients were included in the analysis. The median CD4 cell count was 336 cells/mm3 (IQR: 130-531). Two hundred and seventy-nine patients (53.7%) were classified as LP and 193 (37.1%) as LPAD. On average, 75% of the patients presented with a viral load (VL) >10,000 copies/ml. In multivariate logistic regression analysis the factors associated with LP and LPAD were age, being symptomatic at first visit and VL. Race was a factor associated with LP but not with LPAD. Conclusion: The proportion of patients who were late attending a clinic for HIV treatment is still high, and effective strategies to improve early HIV detection with a special focus on the vulnerable population are urgently needed. .

Prevalence of Disseminated Cryptococcosis among Human Immunodeficiency Virus Infected Patients in Benin City, Nigeria.

Aim: To determine the prevalence of disseminated cryptococcosis among symptomatic HIVinfected patients, attending the Antiretroviral Treatment Clinic at the University of Benin Teaching Hospital, Benin City, Nigeria. Study Design: Cross-sectional study. Place and Duration of Study: Department of Internal Medicine and Department of Medical Microbiology, University of Benin Teaching Hospital, Edo State, Nigeria, between September 2010 and August 2011. Methodology: Five hundred consecutive symptomatic HIV-infected patients, on ART were enrolled into this cross-sectional study (266 males, 234 females, age range 18-81 years, mean age, 40.08 years). A blood sample collected from each participant was screened for serum cryptococcal antigen (CRAG) using the cryptococcal Latex agglutination test. The viral load and CD4+ T -cell count were also determined in parallel. A structured questionnaire was used to gather Information on socio demographic characteristics, medical and treatment history of participants. Data collected and the results of laboratory tests were analyzed using the SPSS software, version 22.0. Results: The prevalence of serum cryptococcal antigen was 9.8%. Majority (66.8%) of the participants had a CD4+ T-cell count of less than 100 cells/μl. The association between serum CRAG and CD4+ T-cell was found to be significant (P < .001). Viral load done for only 90 of the participants was high in 51.1%. The association between serum CRAG and viral load was found to be significant (P < .001). Conclusion: The prevalence of serum CRAG was high among symptomatic HIV- infected patients on ART, in Benin city, Nigeria, despite ART implementation. There is need therefore for a routine cryptococcal antigen test for all symptomatic HIV-infected patients on ART, while further microbiological investigations for those with positive result are recommended for appropriate medical intervention.

What is New in HIV Infection.

Human immunodeficiency virus (HIV) prevention and treatment updates include screening recommendations, fourthgeneration testing, preexposure prophylaxis, and a paradigm shift; treatment is prevention. The U.S. Preventive Services Task Force recommends routine HIV screening in persons 15 to 65 years of age, regardless of risk. Fourth-generation testing is replacing the Western blot and can identify those with acute HIV infection. The U.S. Food and Drug Administration approved the OraQuick In-Home HIV Test; however, there are concerns about reduced sensitivity, possible misinterpretation of results, potential for less effective counseling, and possible cost barriers. Preexposure prophylaxis (effective in select high-risk adult populations) is the combination of safer sex practices and continuous primary care prevention services, plus combination antiretroviral therapy. Concerns for preexposure prophylaxis include the necessity of strict medication adherence, limited use among high-risk populations, and community misconceptions of appropriate use. Evidence supports combination antiretroviral therapy as prevention for acute HIV infection, thus lowering community viral loads. Evidence has increased supporting combination antiretroviral therapy for treatment at any CD4 cell count. Resistance testing should guide therapy in all patients on entry into care. Within two weeks of diagnosis of most opportunistic infections, combination antiretroviral therapy should be started; patients with tuberculosis and cryptococcal meningitis require special considerations.

CD4+ cell count analysis on 1 056 cases of HIV/AIDS treated with TCM for half a year / 国际中医中药杂志

Objective To Analyze CD4+ cell count which embodies curative effect in HIV and patients with AIDS, who have treated with TCM for half a year. Methods According to CD4+cell count, the patients were divided into 4 phases. Their CD4+cell count were analyzed before and after the treatment. Results 1.Rank sun test showed that CD4+cell count were significantly improved in people who used TCM treatment. On the whole, CD4+cell count was(317.76±175.61) in 1 cu mm before treatment, which was(350.60±175.92) in 1 cu mm after treatment, P<0.01. 2. Ridit showed that patients whose CD4+cell count more than 500 were in phase I. Their R=0.614, and the 95%confidence interval was 0.5702 to 0.6579. Patients whose CD4+cell count more than 350 and less than 500 were in phase II. Their R=0.575, and the 95%confidence interval was 0.5439 to 0.6062. Patients whose CD4+cell count more than 200 and less than 350 were inphase III. Their R=0.460 and the 95%confidence interval was 0.4347 to 0.4849. Patients whose CD4+cell count less than 200 were in phase IV. Their R=0.428, and the 95%confidence interval was 0.3971 to 0.4589. There was no overlap between phase III, phase IV and phase I, phase II in 95% confidence interval. Conclusion TCM has the advantages in strengthening vital qi, but that is worse than western medicine in effort of expelling pathogen.

Absolute lymphocyte count: A cost-effective method of monitoring HIV-infected individuals.

Aim: Depletion of CD4 cell count is a hallmark of disease progression in AIDS. CD4 cell count is essential for physicians to decide about the timing of initiation of antiretroviral therapy (ART) and for prophylaxis of opportunistic infections. WHO has recommended that, absolute lymphocyte count (ALC) of ≤1200/μL can substitute CD4 cell count of ≤200/μL in resource-constrained countries throughout the world. Materials and Methods: This study was undertaken to know whether there is a correlation between CD4 cell count and ALC in HIV-infected individuals. A single sample of blood was withdrawn for ALC and CD4 cell count. The samples received from December 1, 2004 to December 31, 2005 were analyzed. Results: A total of 196 samples were collected from 185 patients. After exclusion, a total of 182 samples were analyzed. Results revealed that male:female ratio was 126:56 and their age ranged from 13 to 67 years. The median ALC was 1747 cells/μL, whereas the CD4 cell count ranged from 5 to 2848. The correlation coefficient between ALC and CD4 cell count was significant (0.714). There were 49 patients with an ALC of ≤1200/μL of whom 77.6% patients had CD4 cell count ≤ 200/μL (true positive) and 22.4% had CD4 cell count > 200/μL (false positive). There were 133 patients with an ALC of >1200/μL of whom 84.2% had CD4 cell count > 200/μL (true negative) and 15.8% had CD4 cell count ≤ 200/μL (false negative). Taking ALC of ≤1200/μL as a predictor of CD4 cell count ≤ 200/μL ,the sensitivity of the test was 64.4% and specificity was 91.1%. The positive predictive value was 77.6%, negative predictive value was 84.2%, and accuracy was 82.4%. Conclusion: We found that an ALC of ≤ 1520/μL has higher sensitivity (78%) for a CD4 cell count of ≤ 200/μL. The ALC was found to be significantly cost-effective in our setup but chances of missing out patients requiring ART was 1 in 5 using the WHO guidelines.

CD4 cell count recovery in HIV/TB co-infected patients versus TB uninfected HIV patients.

Background: There is lack of data comparing the improvement in CD4 count following antitubercular (ATT) and antiretroviral therapy (ART) in patients presenting with Human Immunodeficiency Virus/Tuberculosis (HIV/TB) dual infection compared with CD4 matched cohort of TB uninfected HIV patients initiated on ART. We sought to test the hypothesis; TB additionally contributes to reduction in CD4 count in HIV/TB co-infected patients and this would result in greater improvement in count following treatment compared with CD4 matched TB uninfected individuals. Materials and Methods: In a retrospective cohort study design we studied the change in CD4 cell counts in two groups of patients - those with CD4 cell count >100 cells / mm 3 (Group 1) and <100/mm 3 (Group 2) at presentation. In each group the change in CD4 cell count in dually infected patients following six-month ATT and ART was compared to cohorts of CD4 matched TB uninfected patients initiated on ART. Results: In Group 1 (52 patients) dually infected subjects' CD4 count improved from 150 cells/ mm 3 to 345 cells/mm 3 (P=0.001). In the control TB uninfected patients, the change was from 159 cells/mm 3 to 317 cells/mm 3 (P=0.001). Additional improvement in dually infected patients compared to the control group was not statistically significant (P=0.24). In Group 2 (65 patients) dually infected subjects count improved from 49 cells/mm3 to 249 cells/mm 3 (P=0.001) where as in control TB uninfected patients improvement was from 50 cells/ mm 3 to 205 cells/mm 3 (P=0.001), there being statistically significant additional improvement in dually infected subjects (P=0.01). Conclusion: Greater increment in CD4 counts with ATT and ART in dually infected patients suggests that TB additionally influences the reduction of CD4 counts in HIV patients.

Psychosocial Factors Associated with Biological Markers in Korean Patients with Human Immunodeficiency Virus Infection / 신경정신의학

OBJECTIVES: The purpose of this study was to identify psychosocial factors associated with biological markers in Korean patients with human immunodeficiency virus (HIV) infection. METHODS: 50 patients with HIV infection were enrolled. We administered Stress Response Inventory (SRI), the Coping Scale, and the Korean version of Smithklein Beecham quality of life scale (QOL) to the 50 patients and measured CD4+ cell count and HIVRNA copies. RESULTS: Simple correlation analysis showed significant correlation between psychosocial factors and CD4+ cell count. Tension, aggression, depression, frustration subscale in SRI and distancing, self controlling in coping scale had negative correlation with CD4+ cell count, whereas QOL showed positive correlation. Multiple regression analysis showed significant negative association between distancing and CD4+ cell count. There were no differences in CD4+ cell count and HIVRNA between homosexual patients and heterosexual patients. However, aggression, confrontation in SRI, and distancing in coping scale scored significantly higher in heterosexual patients than homosexual patients. CONCLUSION: These results suggest that CD4+ cell count may be associated with psychosocial factors in Korean patients with HIV infection, and passive coping strategy like distancing may be one of important factors in the progression of HIV infection. These findings also suggest that psychosocial intervention programs are needed for Korean patients with HIV infection.