Assuntos
Competência Clínica/normas , Educação Baseada em Competências/normas , Internato e Residência/normas , Radioterapia (Especialidade)/educação , Conselhos de Especialidade Profissional/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Trato Gastrointestinal , Humanos , Melhoria de Qualidade , Radioterapia (Especialidade)/normas , Radioterapia (Especialidade)/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Estados UnidosRESUMO
Most human immunodeficiency virus (HIV)-infected individuals experience increases in peripheral CD4(+) T cell counts with suppressive antiretroviral therapy (ART) that achieves plasma HIV RNA levels that are less than the limit of detection. However, some individuals experience decreasing CD4(+) T cell counts despite suppression of plasma viremia. We evaluated 4 patients with a history of CD4(+) T cell decline despite successfully suppressive ART, from a median of 719 cells/mm(3) (range, 360-1141 cells/mm(3)) to 227 cells/mm(3) (range, 174-311 cells/mm(3)) over a period of 18-24 months; 3 of the patients were receiving tenofovir and didanosine, which may have contributed to this decrease. There was no evidence of HIV replication, nor of antiretroviral drug resistance in the blood or lymphoid tissue, or increased proliferation or decreased thymic production of naive CD4(+) T cells. All 4 patients had significant fibrosis of the T cell zone of lymphoid tissue, which appeared to be an important factor in the failure to reconstitute T cells.
Assuntos
Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/patologia , Infecções por HIV/imunologia , HIV-1/efeitos dos fármacos , Linfócitos T CD4-Positivos/efeitos dos fármacos , Linfócitos T CD4-Positivos/imunologia , DNA Viral/genética , Infecções por HIV/patologia , HIV-1/genética , HIV-1/imunologia , Humanos , Hibridização In Situ , Linfonodos/imunologia , Linfonodos/patologia , Subpopulações de Linfócitos/imunologia , Mutação , RNA Viral/análise , RNA Viral/sangue , Timo/imunologia , Carga ViralRESUMO
The CD4+ T cell count is an important determinant of disease stage and prognosis in human immunodeficiency virus (HIV)-infected individuals. This study evaluated the CD4+ T cell counts in individuals at the time of diagnosis of HIV infection at 4 community clinics in large urban settings with relatively high frequencies of HIV infection. Of 2223 individuals, 57% and 36% had CD4+ T cell counts < 350 and < 200 cells/mm(3), respectively, at the time of diagnosis. There were no clear differences by sex or race. Enhanced educational efforts regarding the importance of HIV testing for at-risk individuals across sex and race strata in community settings may be important for early identification of individuals with HIV infection. This in turn could impact efforts to reduce transmission, and it could impact the prognosis for patients who receive antiretroviral therapy.
