CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy （HAART） and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings....CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy （HAART） and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings. This study examined the correlation between total lymphocyte count （TLC） and CD4 count of HIV-infected patients before and after HAART, and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART. A retrospective study was performed, and 665 HIV-infected patients with TLC and CD4 count from four counties （Shangcai, Queshan, Shenqiu and Weishi） were included in the study. Pearson correlation and receiver operating characteristic （ROC） were used. TLC and CD4 count after HAART was significantly increased as compared with pre-HAART （P〈0.01）. An overall positive correlation was noted between TLC and CD4 count （pre-HAART, r=0.73, P=0.0001; follow-up HAART, r=0.56, P=0.0001）. The ROC curve between TLC and CD4 count showed that TLC ≤ 1200 cells/mm3 could predict CD4 〈 200 cells/mm3 with a sensitivity of 71.12%, specificity of 66.35% at pre-HAART. After 12-month HAART, the optimum prediction for CD4 count 〈 200 cells/mm3 was a TLC ≤ 1300 cells/mm3, with a sensitivity of 63.27%, and a specificity of 74.84%. Further finding indicated that TLC change was positively correlated to CD4 change （r=0.77, P=0.0001） at the time point of 12-month treatment, and the best prediction point of TLC change for CD4 increasing was 135 cells/mm3. TLC and its change can be used as a surrogate marker for CD4 count and its change of HIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.展开更多
Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sec...Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sectional study, 250 HIV-infected patients were groups as follows: ART GrpA (100), ART + traditional medicine use GrpB (100) and ART treatment naïve + traditional medicine GrpC (50). Tubular dysfunctions were defined when at least two or more of the following abnormalities were repeatedly present: Uricosuria ≥ 0.05 mg/dl, Phosphaturia ≥ 20.0 mg/dl, Glucosuria ≥ 0.1 mg/dl, Proteinuria = positive protein on dipstick urine. Renal dysfunctions were found to be significantly high (P = 0.001) in the group of patients treated with ART + traditional medicine. 27 (64.29%) patients followed by ART treatment naïve patients + traditional medicine;12 (28.57%) patients and only 4 (7.14%) patients developed renal toxicity in the ART treatment Grp. But strikingly CD4 counts were also significantly higher in Grp B (683 cell/ul) compared to group A (446 cell/ul) and C (206 cell/ul). Our results show that HIV-infected patients on ART combined with traditional medicine might develop renal abnormalities in the presence of high CD4 counts, in the course of incessant use of traditional medicine. Thus it is important that more research be conducted on its usage among the Black population with HIV infection.展开更多
Background: It is widely known that the human immune-deficiency virus (HIV) induces biochemical and physiological changes in affected persons. Consequently, the overall aim of this study was to evaluate the HIV-1 RNA ...Background: It is widely known that the human immune-deficiency virus (HIV) induces biochemical and physiological changes in affected persons. Consequently, the overall aim of this study was to evaluate the HIV-1 RNA viral load, CD4 count, and certain haematological parameters among HIV treatment-na?ve subjects in the Enugu metropolis of Nigeria. Materials and Methods: A total of 252 HIV-infected, ART-native subjects (≥18) attending the University of Nigeria Teaching Hospital (UNTH) in Ituku-Ozalla, Enugu were recruited for this study and were made up of 157 (62.3%) females and 95 (37.7%) males. A total of 250 HIV-negative subjects were used as control subjects (100 males and 150 females). Blood samples were collected from all the participants and their HIV-1 status was confirmed by an immunoblot confirmatory test. Their haematological parameters and CD4 count were evaluated, while the HIV-1 viral load was only assessed on confirmed HIV-positive subjects. Results: There was female predominance (62.3%) among these HIV-positive subjects. The mean age of HIV-positive subjects was 39.16 ± 10.08 years while the mean age of the control subjects was 34.8 ± 8.6 years. The age group of 31 - 40 years (102/252 (40.5%)) constituted most of the test subjects. The total white blood cells (TWBC) (6.05 ± 5.46), lymphocyte counts (36 ± 14), haemoglobin concentrations (Hb) (9.85 ± 7.36) and the CD4 counts (242 ± 228) of the HIV-infected subjects showed a significant difference when compared with their control counterpart values of TWBC (4.5 ± 0.568), lymphocytes (39.67 ± 8.2), Hb (13.48 ± 1.5), and CD4 counts (807 ± 249) (p 0.05). Anaemia, lymphocytopenia, and thrombocytopenia were the haematological abnormalities seen in the HIV-positive subjects. HIV viral load correlated with haemoglobin concentration, CD4 count, lymphocyte count, and neutrophil count (p Conclusion: Prognostic factors, such as haemoglobin concentrations, CD4 counts, lymphocyte counts, and neutrophil counts can be used to monitor patients’ viral loads since they correlate with the latter;furthermore, age is a factor that should be considered in the management of HIV-positive patients.展开更多
Introduction: With advances in the management of patients living with HIV and AIDS (PLHA), not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovasc...Introduction: With advances in the management of patients living with HIV and AIDS (PLHA), not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Aims and Objectives: To determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection and to evaluate their correlation with CD4 count. Materials and Method: 70 consecutive patients with HIV infection admitted to Post Graduate Department of Medicine from the period of July 2010 to August 2011 were studied. All cases of PLHA diagnosed after positive ELISA test for HIV infection were included, whereas those with congenital heart disease, rheumatic heart disease, hypertension, Ischemic heart disease were excluded from the study. CD4 count and 2D echocardiography along with routine investigations were done for all patients. Result: Male to female ratio was 2:1. Echocardiographic abnormalities were seen in 58% of patients. Reduced ejection fraction (below 50%) and fractional shortening below 30% were the most common cardiac abnormality (48.7%) followed by pericardial effusion (17.4%), pulmonary artery hypertension (11.4%), dilated cardiomyopathy (8.5%), diastolic dysfunction (8.5%) and regional wall motion abnormality (1.4%) respectively. Significant statistical positive correlation was observed between low CD4 count and echocardiographic abnormalities (p < 0.0001). Pericardial effusion was seen more in patients with CD4 count below 200 (p < 0.001). Maximum number of echocardiographic abnormalities was seen in WHO clinical stage IV. Conclusions: Cardiac manifestations are frequent PLHA in our population but do not have detectable clinical manifestation. Echocardiographic abnormalities have a strong correlation with low CD4 count and occur more in advanced stage of the disease.展开更多
National Free Traditional Chinese Medicine (TCM) HIV/AIDS Treatment Program had been carried out for more than 5 years, treating 9267 cases accumulately by 2009. We report the 3-year outcome on CD4+ lymphocyte count o...National Free Traditional Chinese Medicine (TCM) HIV/AIDS Treatment Program had been carried out for more than 5 years, treating 9267 cases accumulately by 2009. We report the 3-year outcome on CD4+ lymphocyte count of 807 cases of HIV/AIDS enrolled in the National Free TCM HIV/AIDS Treatment Pro- gram, the CD4+ lymphocyte count were measured every 6 month at 7 time points (0, 6, 12, 18, 24, 30, 36 month). The results showed that the overall CD4+ ly mphocyte count maintained stable at the 6th month and the 12th month, declined significantly at the 18th month, 24th month and 30th month, then elevated to the pre-treatment level at the 36th month. Patients with pre-treatment CD4+ lymphocyte count level 350/mm3 had CD4+ lymphocyte count declined significantly after all visits. In summary, combined treatment of Chinese herbal medicine and conventional therapy on HIV/AIDS suggested promising effect, but more evidences from larger, rigorous designed studies still needed to support the affirmative effect of TCM in the future.展开更多
Acquired Immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Viruses (HIV) resulting in progressive destruction of cell mediated immunity. The abdominal manifestations of AIDS are related to the level...Acquired Immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Viruses (HIV) resulting in progressive destruction of cell mediated immunity. The abdominal manifestations of AIDS are related to the level of CD+4 cells count as well as viral load. Abdominal ultrasound examination is easy to perform, non-invasive, inexpensive, readily available and reproducible investigation which provides valuable information about abdominal findings in AIDS. The objective of the study was to evaluate abdominal ultrasound findings in adult HIV/AIDS patients in Jos, Plateau State, Nigeria and correlate these findings with the patients’ CD+4 counts. A cross-sectional study of abdominal ultrasound findings of adult patients with HIV/AIDS was conducted over a period of six months. The abdominal ultrasound findings and CD+4 counts were studied. Two hundred (40%) of the patients had normal abdominal ultrasound, while 60% (300) had various abnormalities. The common abnormalities included increased liver parenchymal echogenicity in 25.0%, hepatomegaly in 23.4%, splenomegaly in 6.6%, increased splenic echogenicity in 6.2% and thickened gallbladder wall in 12.6%, elevated renal parenchymal echogenicity in 6.4%, enlarged kidneys in 2.6%, lymphadenopathy in 6.0%, and ascites in 2.4%. Pelvic abscess was the least pathology in 0.2%. Most of the findings did not correlate with the patients’ CD+4?count except for lymphadenopathy and ascites. Although abdominal ultrasound examination is invaluable in the management of these patients, however, it has not shown to be useful in predicting the patients’ immune status.展开更多
Survival of HIV/AIDS patients is crucially dependent on comprehensive and targeted medical interventions such as supply of antiretroviral therapy and monitoring disease progression with CD4 T-cell counts. Statistical ...Survival of HIV/AIDS patients is crucially dependent on comprehensive and targeted medical interventions such as supply of antiretroviral therapy and monitoring disease progression with CD4 T-cell counts. Statistical modelling approaches are helpful towards this goal. This study aims at developing Bayesian joint models with assumed generalized error distribution (GED) for the longitudinal CD4 data and two accelerated failure time distributions, Lognormal and loglogistic, for the survival time of HIV/AIDS patients. Data are obtained from patients under antiretroviral therapy follow-up at Shashemene referral hospital during January 2006-January 2012 and at Bale Robe general hospital during January 2008-March 2015. The Bayesian joint models are defined through latent variables and association parameters and with specified non-informative prior distributions for the model parameters. Simulations are conducted using Gibbs sampler algorithm implemented in the WinBUGS software. The results of the analyses of the two different data sets show that distributions of measurement errors of the longitudinal CD4 variable follow the generalized error distribution with fatter tails than the normal distribution. The Bayesian joint GED loglogistic models fit better to the data sets compared to the lognormal cases. Findings reveal that patients’ health can be improved over time. Compared to the males, female patients gain more CD4 counts. Survival time of a patient is negatively affected by TB infection. Moreover, increase in number of opportunistic infection implies decline of CD4 counts. Patients’ age negatively affects the disease marker with no effects on survival time. Improving weight may improve survival time of patients. Bayesian joint models with GED and AFT distributions are found to be useful in modelling the longitudinal and survival processes. Thus we recommend the generalized error distributions for measurement errors of the longitudinal data under the Bayesian joint modelling. Further studies may investigate the models with various types of shared random effects and more covariates with predictions.展开更多
Objective:To investigate the prevalence of microbial antigenic components of circulating immune complexes amongst grades of CD4 T lymphocyte counts in HIV sero positive and seronegative participants.Methods:Polyethele...Objective:To investigate the prevalence of microbial antigenic components of circulating immune complexes amongst grades of CD4 T lymphocyte counts in HIV sero positive and seronegative participants.Methods:Polyethelene glycol(PEG-600) and buffering methods of precipitation and dissociation of immune complexes was used to generate immune solution from sera of 100 HIV sero-positive and 100 HIV sero-negative participants.These were categorized into 3 grades based on CD4 count:】 500 cell/mm,200-499 cell/mm3 and 【200 cell/mm3.The immune solutions were assayed using membrane based immunoassay and antibody titration, along side its unprocessed serum for detection of various microbial antigens and or antibodies. CD4 T cell counts were estimated using Patec Cyflow SL-3 Germany.Results:Antigenic component of immune complexes of various infectious agents was detected in 99 and 70 HIV seropositive and HIV sero-negative participants,respectively.In group A,there were 10 HIV positive participants,including 4(40.0%) had circulating immune complexes(CICs) due to Salmonella species only:1(10.0%) due to Salmonella-Plasmodium falciparum(P.falciparum),SalmonellaP. falciparum-HCV and P.falciparum antigens,respectively.In group B,45(45.4%) HIV seropositive participants with CICs had CD4 T lymphocyte count between 200-499 cells/mm^3.Out of these,20(44.4%) had CICs due to Salmonella species only:9(20%) due to Salmonella-P. falciparum.In group C,there were 44(44.4%) HIV sero-positive participants,including 3(6.8%) due to Salmonella species only:24(54.4%) due to Salmonella-P.falciparum:2(4.5%) due to P. falciparum only.Conclusions:In HIV sero-positive participants,presence of heterogeneity of Salmonella species-P.falciparum antigens was highly incriminated in CD4 count depletion but not homogeneity of malaria parasites antigens.Malaria parasites antigens only were incriminated in CD4^+ count depletion amongst HIV sero-negative participants.Before taking any decision on the management of HIV-1-positive individuals,their malaria and Salmonella paratyphi status should be assessed,but not malaria status alone.展开更多
Sustained heavy ethanol drinking is a common problem globally and ethanol is one of the most abused drugs among individuals of different socio-economic status including the HIV-infected patients on antiretroviral drug...Sustained heavy ethanol drinking is a common problem globally and ethanol is one of the most abused drugs among individuals of different socio-economic status including the HIV-infected patients on antiretroviral drugs. Ethanol is reward drug and a CNS depressant especially at high doses. The study determined the effect of sustained heavy ethanol drinking by HIV-infected patients on d4T/3TC/NVP regimen on CD4+ cell counts in Uganda using WHO AUDIT tool and chronic alcohol-use biomarkers. A case control study using repeated measures design with serial measurements model was used. The patients on stavudine (d4T) 30 mg, lamivudine (3TC) 150 mg and nevirapine (NVP) 200 mg and chronic alcohol use were recruited. A total of 41 patients (20 in alcohol group and 21 in control group) were screened for chronic alcohol use by WHO AUDIT tool and chronic alcohol use biomarkers. They were followed up for 9 months with blood sampling done at 3 months intervals. CD4+ cell count was determined using Facscalibur Flow Cytometer system. Results were then sorted by alcohol-use biomarkers (GGT, MCV and AST/ ALT ratio). Data were analysed using SAS 2003 version 9.1 statistical package with repeated measures fixed model and the means were compared using student t-test. The mean CD4+ cell counts in all the groups were lower than the reference ranges at baseline and gradually increased at 3, 6 and 9 months of follow-up. The mean CD4+ cell counts were higher in the control group as compared to the chronic alcohol use group in both WHO AUDIT tool group and chronic alcohol-use biomarkers group though there was no significant difference (p > 0.05). Chronic alcohol use slightly lowers CD4+ cell count in HIV-infected patients on d4T/3TC/NVP treatment regimen.展开更多
<strong><em>Background: </em></strong>The appropriate time to initiate antiretroviral therapy (ART) in HIV/AIDS patients is determined by measurement of CD4+/CD8+ T cell count. The CD4/CD8+ T c...<strong><em>Background: </em></strong>The appropriate time to initiate antiretroviral therapy (ART) in HIV/AIDS patients is determined by measurement of CD4+/CD8+ T cell count. The CD4/CD8+ T cell count is also useful, together with viral load, in monitoring disease progression and effectiveness treatment regimens. Several factors may contribute to sample rejection during the CD4+/CD8+ T cells count, resulting in negative effects on patient management. <strong> <em>Objective: </em></strong>Evaluate the causes for CD4+CD8+ T cell count sample rejection at the Kenyatta National Hospital Comprehensive Care Center Laboratory. <strong><em>Method:</em></strong> A retrospective cross-sectional study was conducted between 2018 and 2020. Data was obtained from the “rejected samples” for Partec<sup>R</sup> FlowCyp flow cytometry file. Designed data collection sheet was used for data capture. A total of 3972 samples were submitted for CD4+/CD8+ T cell count during the study period. Causes for sample rejection were numbered 1 to 12, each representing a reason for sample rejection. Number 1 was sub-categorized into clotted, hemolyzed, short-draw and lipemic. Data was analyzed using excel, and presented using tables, graphs and pie charts. Approval to conduct the study was obtained from KNH/UoN ERC. <strong> <em>Results: </em></strong>In the study period, 81/3972 (2.0%) samples were rejected. Samples submitted more than 48 hours after collection were mostly rejected. Other factors included improper collection technique, delayed testing, patient identification error and incorrect use of vacutainer. A combination of clotted samples, specimen submission more than 48 hours caused the most frequent sample rejection, followed with combination of specimen submission more than 48 hours, delayed testing and delayed specimen processing. Together, clotted samples, incorrect vacutainer and poor specimen label caused the least sample rejection. <strong><em>Conclusion:</em></strong> Sample rejection rate for CD4/CD8+ T cell count was relatively low, and multiple factors contributed to rejection. However, improved quality assurance will enable more benefit to patients who seek this test in the laboratory.展开更多
Toxoplasma gondii (T. gondii) is a parasite responsible of toxoplasmosis, a disease often asymptomatic but with serious consequences in pregnant women and immunocompromised subjects. Objective: This study aimed to inv...Toxoplasma gondii (T. gondii) is a parasite responsible of toxoplasmosis, a disease often asymptomatic but with serious consequences in pregnant women and immunocompromised subjects. Objective: This study aimed to investigate the impact of T. gondii infection on CD4+ T lymphocytes count in HIV-infected pregnant women. Methods: This was a cross-sectional study of pregnant women co-infected by HIV and T. gondii. The study was conducted from January to July 2016 at the Prevention of Mother-to-Child Transmission of HIV (PMTCT) sites in the Health District of Lacs in Togo. Diagnosis of HIV was performed by immuno-chromatographic methods with Determine TM HIV-1/2 and immuno-filtration with Tri-Dot HIV-1 and 2 kits. Presence of anti-toxoplasmic IgG and IgM antibodies was established via enzyme immunoassay using ELISA-BIOREX®kit. Flow cytometry was used to count CD4+ T lymphocytes. Results: Our study found that of the 4599 pregnant women, 111 (2.41%) were HIV-positive. Among them, 109 (98.20%) were infected by HIV-1 and 2 (1.98%) by HIV-2. Antibodies against T. gondii were detected in 5.36% (IgM), 25% (IgG) and 3.57% (both IgM and IgG) of HIV 56 infected women. There was no significant difference between CD4 cell count in HIV (+)/T. gondii IgM (-)/IgG (-) infected pregnant women (378.8 ± 222.8 cell//μl) compared to HIV (+)/T. gondii/IgM (+) (457.3 ± 183.3 cell//μl), HIV (+)/T. gondii IgG (+) (419.4 ± 287.3 cell//μl) and HIV (+)/T. gondii IgM/IgG (+) (480.5 ± 252.4 cell/μl). Conclusion: This study showed that intracellular parasite T. gondii did not alter CD4+ T lymphocytes count in HIV/T. gondii co-infected pregnant women.展开更多
目的分析单核细胞人白细胞DR抗原(mHLA-DR)、中性粒细胞与淋巴细胞比值(NLR)及CD4^(+)T淋巴细胞对脓毒症患者预后的预测价值.方法收集2023年12月至2024年9月入住青岛市市立医院重症医学科的29例脓毒症患作为研究对象,根据28 d预后将患...目的分析单核细胞人白细胞DR抗原(mHLA-DR)、中性粒细胞与淋巴细胞比值(NLR)及CD4^(+)T淋巴细胞对脓毒症患者预后的预测价值.方法收集2023年12月至2024年9月入住青岛市市立医院重症医学科的29例脓毒症患作为研究对象,根据28 d预后将患者分为存活组(20例)与死亡组(9例).收集患者入院时的基线资料[包括患者的性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、白细胞计数(WBC)、NLR、血红蛋白(Hb)、血小板计数(PLT)、C-反应蛋白(CRP)、总蛋白(TP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(Cr)、CD4^(+)T淋巴细胞计数]和入院1、3、7 d mHLA-DR水平,并计算入院3 d、7 d mHLA-DR表达率与入院1 d的差值,记为ΔH3、ΔH7.比较不同预后两组患者上述指标的差异.绘制受试者工作特征曲线(ROC曲线)评价mHLA-DR、NLR、CD4^(+)T淋巴细胞计数、SOFA评分及APACHEⅡ评分对脓毒症患者28 d死亡风险的预测价值.结果与存活组比较,死亡组APACHEⅡ评分、SOFA评分、NLR均明显升高,ΔH7、CD4^(+)T淋巴细胞计数均明显降低(均P<0.05).ROC曲线分析显示:ΔH7、NLR、CD4^(+)T淋巴细胞计数、SOFA评分及APACHEⅡ评分均对脓毒症患者28 d预后均有预测价值,ROC曲线下面积(AUC)和95%可信区间(95%CI)分别为0.817(0.635~0.999)、0.789(0.611~0.966)、0.786(0.588~0.985)、0.853(0.685~1.000)、0.844(0.659~1.000),均P<0.05.ΔH7联合NLR、ΔH7联合CD4^(+)T淋巴细胞、NLR联合CD4^(+)T淋巴细胞以及ΔH7、NLR、CD4^(+)T淋巴细胞3者联合检测对脓毒症患者28 d预后亦有预测价值,AUC和95%CI分别为0.867(0.735~0.998)、0.878(0.752~1.000)、0.883(0.760~1.000)、0.928(0.837~1.000),均P<0.05.结论脓毒症患者入院1 d NLR及CD4^(+)T淋巴细胞计数可预测脓毒症患者预后,动态监测脓毒症患者mHLA-DR水平同样可以预测脓毒症患者预后,然而7 d内单次测定mHLA-DR水平没有意义.就单指标而言,ΔH7在ΔH7、NLR、CD4^(+)T淋巴细胞计数3个指标中对于脓毒症患者预后的预测价值最佳,3个指标联合检测对脓毒症患者预后判断更具优势.展开更多
基金supported by a grant from the Key Projects in the National Science & Technology Pillar Program during the Eleventh Five-Year Plan Period of China (No. 2009ZX10001-017)
文摘CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy （HAART） and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings. This study examined the correlation between total lymphocyte count （TLC） and CD4 count of HIV-infected patients before and after HAART, and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART. A retrospective study was performed, and 665 HIV-infected patients with TLC and CD4 count from four counties （Shangcai, Queshan, Shenqiu and Weishi） were included in the study. Pearson correlation and receiver operating characteristic （ROC） were used. TLC and CD4 count after HAART was significantly increased as compared with pre-HAART （P〈0.01）. An overall positive correlation was noted between TLC and CD4 count （pre-HAART, r=0.73, P=0.0001; follow-up HAART, r=0.56, P=0.0001）. The ROC curve between TLC and CD4 count showed that TLC ≤ 1200 cells/mm3 could predict CD4 〈 200 cells/mm3 with a sensitivity of 71.12%, specificity of 66.35% at pre-HAART. After 12-month HAART, the optimum prediction for CD4 count 〈 200 cells/mm3 was a TLC ≤ 1300 cells/mm3, with a sensitivity of 63.27%, and a specificity of 74.84%. Further finding indicated that TLC change was positively correlated to CD4 change （r=0.77, P=0.0001） at the time point of 12-month treatment, and the best prediction point of TLC change for CD4 increasing was 135 cells/mm3. TLC and its change can be used as a surrogate marker for CD4 count and its change of HIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.
文摘Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sectional study, 250 HIV-infected patients were groups as follows: ART GrpA (100), ART + traditional medicine use GrpB (100) and ART treatment naïve + traditional medicine GrpC (50). Tubular dysfunctions were defined when at least two or more of the following abnormalities were repeatedly present: Uricosuria ≥ 0.05 mg/dl, Phosphaturia ≥ 20.0 mg/dl, Glucosuria ≥ 0.1 mg/dl, Proteinuria = positive protein on dipstick urine. Renal dysfunctions were found to be significantly high (P = 0.001) in the group of patients treated with ART + traditional medicine. 27 (64.29%) patients followed by ART treatment naïve patients + traditional medicine;12 (28.57%) patients and only 4 (7.14%) patients developed renal toxicity in the ART treatment Grp. But strikingly CD4 counts were also significantly higher in Grp B (683 cell/ul) compared to group A (446 cell/ul) and C (206 cell/ul). Our results show that HIV-infected patients on ART combined with traditional medicine might develop renal abnormalities in the presence of high CD4 counts, in the course of incessant use of traditional medicine. Thus it is important that more research be conducted on its usage among the Black population with HIV infection.
文摘Background: It is widely known that the human immune-deficiency virus (HIV) induces biochemical and physiological changes in affected persons. Consequently, the overall aim of this study was to evaluate the HIV-1 RNA viral load, CD4 count, and certain haematological parameters among HIV treatment-na?ve subjects in the Enugu metropolis of Nigeria. Materials and Methods: A total of 252 HIV-infected, ART-native subjects (≥18) attending the University of Nigeria Teaching Hospital (UNTH) in Ituku-Ozalla, Enugu were recruited for this study and were made up of 157 (62.3%) females and 95 (37.7%) males. A total of 250 HIV-negative subjects were used as control subjects (100 males and 150 females). Blood samples were collected from all the participants and their HIV-1 status was confirmed by an immunoblot confirmatory test. Their haematological parameters and CD4 count were evaluated, while the HIV-1 viral load was only assessed on confirmed HIV-positive subjects. Results: There was female predominance (62.3%) among these HIV-positive subjects. The mean age of HIV-positive subjects was 39.16 ± 10.08 years while the mean age of the control subjects was 34.8 ± 8.6 years. The age group of 31 - 40 years (102/252 (40.5%)) constituted most of the test subjects. The total white blood cells (TWBC) (6.05 ± 5.46), lymphocyte counts (36 ± 14), haemoglobin concentrations (Hb) (9.85 ± 7.36) and the CD4 counts (242 ± 228) of the HIV-infected subjects showed a significant difference when compared with their control counterpart values of TWBC (4.5 ± 0.568), lymphocytes (39.67 ± 8.2), Hb (13.48 ± 1.5), and CD4 counts (807 ± 249) (p 0.05). Anaemia, lymphocytopenia, and thrombocytopenia were the haematological abnormalities seen in the HIV-positive subjects. HIV viral load correlated with haemoglobin concentration, CD4 count, lymphocyte count, and neutrophil count (p Conclusion: Prognostic factors, such as haemoglobin concentrations, CD4 counts, lymphocyte counts, and neutrophil counts can be used to monitor patients’ viral loads since they correlate with the latter;furthermore, age is a factor that should be considered in the management of HIV-positive patients.
文摘Introduction: With advances in the management of patients living with HIV and AIDS (PLHA), not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Aims and Objectives: To determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection and to evaluate their correlation with CD4 count. Materials and Method: 70 consecutive patients with HIV infection admitted to Post Graduate Department of Medicine from the period of July 2010 to August 2011 were studied. All cases of PLHA diagnosed after positive ELISA test for HIV infection were included, whereas those with congenital heart disease, rheumatic heart disease, hypertension, Ischemic heart disease were excluded from the study. CD4 count and 2D echocardiography along with routine investigations were done for all patients. Result: Male to female ratio was 2:1. Echocardiographic abnormalities were seen in 58% of patients. Reduced ejection fraction (below 50%) and fractional shortening below 30% were the most common cardiac abnormality (48.7%) followed by pericardial effusion (17.4%), pulmonary artery hypertension (11.4%), dilated cardiomyopathy (8.5%), diastolic dysfunction (8.5%) and regional wall motion abnormality (1.4%) respectively. Significant statistical positive correlation was observed between low CD4 count and echocardiographic abnormalities (p < 0.0001). Pericardial effusion was seen more in patients with CD4 count below 200 (p < 0.001). Maximum number of echocardiographic abnormalities was seen in WHO clinical stage IV. Conclusions: Cardiac manifestations are frequent PLHA in our population but do not have detectable clinical manifestation. Echocardiographic abnormalities have a strong correlation with low CD4 count and occur more in advanced stage of the disease.
文摘National Free Traditional Chinese Medicine (TCM) HIV/AIDS Treatment Program had been carried out for more than 5 years, treating 9267 cases accumulately by 2009. We report the 3-year outcome on CD4+ lymphocyte count of 807 cases of HIV/AIDS enrolled in the National Free TCM HIV/AIDS Treatment Pro- gram, the CD4+ lymphocyte count were measured every 6 month at 7 time points (0, 6, 12, 18, 24, 30, 36 month). The results showed that the overall CD4+ ly mphocyte count maintained stable at the 6th month and the 12th month, declined significantly at the 18th month, 24th month and 30th month, then elevated to the pre-treatment level at the 36th month. Patients with pre-treatment CD4+ lymphocyte count level 350/mm3 had CD4+ lymphocyte count declined significantly after all visits. In summary, combined treatment of Chinese herbal medicine and conventional therapy on HIV/AIDS suggested promising effect, but more evidences from larger, rigorous designed studies still needed to support the affirmative effect of TCM in the future.
文摘Acquired Immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Viruses (HIV) resulting in progressive destruction of cell mediated immunity. The abdominal manifestations of AIDS are related to the level of CD+4 cells count as well as viral load. Abdominal ultrasound examination is easy to perform, non-invasive, inexpensive, readily available and reproducible investigation which provides valuable information about abdominal findings in AIDS. The objective of the study was to evaluate abdominal ultrasound findings in adult HIV/AIDS patients in Jos, Plateau State, Nigeria and correlate these findings with the patients’ CD+4 counts. A cross-sectional study of abdominal ultrasound findings of adult patients with HIV/AIDS was conducted over a period of six months. The abdominal ultrasound findings and CD+4 counts were studied. Two hundred (40%) of the patients had normal abdominal ultrasound, while 60% (300) had various abnormalities. The common abnormalities included increased liver parenchymal echogenicity in 25.0%, hepatomegaly in 23.4%, splenomegaly in 6.6%, increased splenic echogenicity in 6.2% and thickened gallbladder wall in 12.6%, elevated renal parenchymal echogenicity in 6.4%, enlarged kidneys in 2.6%, lymphadenopathy in 6.0%, and ascites in 2.4%. Pelvic abscess was the least pathology in 0.2%. Most of the findings did not correlate with the patients’ CD+4?count except for lymphadenopathy and ascites. Although abdominal ultrasound examination is invaluable in the management of these patients, however, it has not shown to be useful in predicting the patients’ immune status.
文摘Survival of HIV/AIDS patients is crucially dependent on comprehensive and targeted medical interventions such as supply of antiretroviral therapy and monitoring disease progression with CD4 T-cell counts. Statistical modelling approaches are helpful towards this goal. This study aims at developing Bayesian joint models with assumed generalized error distribution (GED) for the longitudinal CD4 data and two accelerated failure time distributions, Lognormal and loglogistic, for the survival time of HIV/AIDS patients. Data are obtained from patients under antiretroviral therapy follow-up at Shashemene referral hospital during January 2006-January 2012 and at Bale Robe general hospital during January 2008-March 2015. The Bayesian joint models are defined through latent variables and association parameters and with specified non-informative prior distributions for the model parameters. Simulations are conducted using Gibbs sampler algorithm implemented in the WinBUGS software. The results of the analyses of the two different data sets show that distributions of measurement errors of the longitudinal CD4 variable follow the generalized error distribution with fatter tails than the normal distribution. The Bayesian joint GED loglogistic models fit better to the data sets compared to the lognormal cases. Findings reveal that patients’ health can be improved over time. Compared to the males, female patients gain more CD4 counts. Survival time of a patient is negatively affected by TB infection. Moreover, increase in number of opportunistic infection implies decline of CD4 counts. Patients’ age negatively affects the disease marker with no effects on survival time. Improving weight may improve survival time of patients. Bayesian joint models with GED and AFT distributions are found to be useful in modelling the longitudinal and survival processes. Thus we recommend the generalized error distributions for measurement errors of the longitudinal data under the Bayesian joint modelling. Further studies may investigate the models with various types of shared random effects and more covariates with predictions.
文摘Objective:To investigate the prevalence of microbial antigenic components of circulating immune complexes amongst grades of CD4 T lymphocyte counts in HIV sero positive and seronegative participants.Methods:Polyethelene glycol(PEG-600) and buffering methods of precipitation and dissociation of immune complexes was used to generate immune solution from sera of 100 HIV sero-positive and 100 HIV sero-negative participants.These were categorized into 3 grades based on CD4 count:】 500 cell/mm,200-499 cell/mm3 and 【200 cell/mm3.The immune solutions were assayed using membrane based immunoassay and antibody titration, along side its unprocessed serum for detection of various microbial antigens and or antibodies. CD4 T cell counts were estimated using Patec Cyflow SL-3 Germany.Results:Antigenic component of immune complexes of various infectious agents was detected in 99 and 70 HIV seropositive and HIV sero-negative participants,respectively.In group A,there were 10 HIV positive participants,including 4(40.0%) had circulating immune complexes(CICs) due to Salmonella species only:1(10.0%) due to Salmonella-Plasmodium falciparum(P.falciparum),SalmonellaP. falciparum-HCV and P.falciparum antigens,respectively.In group B,45(45.4%) HIV seropositive participants with CICs had CD4 T lymphocyte count between 200-499 cells/mm^3.Out of these,20(44.4%) had CICs due to Salmonella species only:9(20%) due to Salmonella-P. falciparum.In group C,there were 44(44.4%) HIV sero-positive participants,including 3(6.8%) due to Salmonella species only:24(54.4%) due to Salmonella-P.falciparum:2(4.5%) due to P. falciparum only.Conclusions:In HIV sero-positive participants,presence of heterogeneity of Salmonella species-P.falciparum antigens was highly incriminated in CD4 count depletion but not homogeneity of malaria parasites antigens.Malaria parasites antigens only were incriminated in CD4^+ count depletion amongst HIV sero-negative participants.Before taking any decision on the management of HIV-1-positive individuals,their malaria and Salmonella paratyphi status should be assessed,but not malaria status alone.
文摘Sustained heavy ethanol drinking is a common problem globally and ethanol is one of the most abused drugs among individuals of different socio-economic status including the HIV-infected patients on antiretroviral drugs. Ethanol is reward drug and a CNS depressant especially at high doses. The study determined the effect of sustained heavy ethanol drinking by HIV-infected patients on d4T/3TC/NVP regimen on CD4+ cell counts in Uganda using WHO AUDIT tool and chronic alcohol-use biomarkers. A case control study using repeated measures design with serial measurements model was used. The patients on stavudine (d4T) 30 mg, lamivudine (3TC) 150 mg and nevirapine (NVP) 200 mg and chronic alcohol use were recruited. A total of 41 patients (20 in alcohol group and 21 in control group) were screened for chronic alcohol use by WHO AUDIT tool and chronic alcohol use biomarkers. They were followed up for 9 months with blood sampling done at 3 months intervals. CD4+ cell count was determined using Facscalibur Flow Cytometer system. Results were then sorted by alcohol-use biomarkers (GGT, MCV and AST/ ALT ratio). Data were analysed using SAS 2003 version 9.1 statistical package with repeated measures fixed model and the means were compared using student t-test. The mean CD4+ cell counts in all the groups were lower than the reference ranges at baseline and gradually increased at 3, 6 and 9 months of follow-up. The mean CD4+ cell counts were higher in the control group as compared to the chronic alcohol use group in both WHO AUDIT tool group and chronic alcohol-use biomarkers group though there was no significant difference (p > 0.05). Chronic alcohol use slightly lowers CD4+ cell count in HIV-infected patients on d4T/3TC/NVP treatment regimen.
文摘<strong><em>Background: </em></strong>The appropriate time to initiate antiretroviral therapy (ART) in HIV/AIDS patients is determined by measurement of CD4+/CD8+ T cell count. The CD4/CD8+ T cell count is also useful, together with viral load, in monitoring disease progression and effectiveness treatment regimens. Several factors may contribute to sample rejection during the CD4+/CD8+ T cells count, resulting in negative effects on patient management. <strong> <em>Objective: </em></strong>Evaluate the causes for CD4+CD8+ T cell count sample rejection at the Kenyatta National Hospital Comprehensive Care Center Laboratory. <strong><em>Method:</em></strong> A retrospective cross-sectional study was conducted between 2018 and 2020. Data was obtained from the “rejected samples” for Partec<sup>R</sup> FlowCyp flow cytometry file. Designed data collection sheet was used for data capture. A total of 3972 samples were submitted for CD4+/CD8+ T cell count during the study period. Causes for sample rejection were numbered 1 to 12, each representing a reason for sample rejection. Number 1 was sub-categorized into clotted, hemolyzed, short-draw and lipemic. Data was analyzed using excel, and presented using tables, graphs and pie charts. Approval to conduct the study was obtained from KNH/UoN ERC. <strong> <em>Results: </em></strong>In the study period, 81/3972 (2.0%) samples were rejected. Samples submitted more than 48 hours after collection were mostly rejected. Other factors included improper collection technique, delayed testing, patient identification error and incorrect use of vacutainer. A combination of clotted samples, specimen submission more than 48 hours caused the most frequent sample rejection, followed with combination of specimen submission more than 48 hours, delayed testing and delayed specimen processing. Together, clotted samples, incorrect vacutainer and poor specimen label caused the least sample rejection. <strong><em>Conclusion:</em></strong> Sample rejection rate for CD4/CD8+ T cell count was relatively low, and multiple factors contributed to rejection. However, improved quality assurance will enable more benefit to patients who seek this test in the laboratory.
文摘Toxoplasma gondii (T. gondii) is a parasite responsible of toxoplasmosis, a disease often asymptomatic but with serious consequences in pregnant women and immunocompromised subjects. Objective: This study aimed to investigate the impact of T. gondii infection on CD4+ T lymphocytes count in HIV-infected pregnant women. Methods: This was a cross-sectional study of pregnant women co-infected by HIV and T. gondii. The study was conducted from January to July 2016 at the Prevention of Mother-to-Child Transmission of HIV (PMTCT) sites in the Health District of Lacs in Togo. Diagnosis of HIV was performed by immuno-chromatographic methods with Determine TM HIV-1/2 and immuno-filtration with Tri-Dot HIV-1 and 2 kits. Presence of anti-toxoplasmic IgG and IgM antibodies was established via enzyme immunoassay using ELISA-BIOREX®kit. Flow cytometry was used to count CD4+ T lymphocytes. Results: Our study found that of the 4599 pregnant women, 111 (2.41%) were HIV-positive. Among them, 109 (98.20%) were infected by HIV-1 and 2 (1.98%) by HIV-2. Antibodies against T. gondii were detected in 5.36% (IgM), 25% (IgG) and 3.57% (both IgM and IgG) of HIV 56 infected women. There was no significant difference between CD4 cell count in HIV (+)/T. gondii IgM (-)/IgG (-) infected pregnant women (378.8 ± 222.8 cell//μl) compared to HIV (+)/T. gondii/IgM (+) (457.3 ± 183.3 cell//μl), HIV (+)/T. gondii IgG (+) (419.4 ± 287.3 cell//μl) and HIV (+)/T. gondii IgM/IgG (+) (480.5 ± 252.4 cell/μl). Conclusion: This study showed that intracellular parasite T. gondii did not alter CD4+ T lymphocytes count in HIV/T. gondii co-infected pregnant women.
文摘目的分析单核细胞人白细胞DR抗原(mHLA-DR)、中性粒细胞与淋巴细胞比值(NLR)及CD4^(+)T淋巴细胞对脓毒症患者预后的预测价值.方法收集2023年12月至2024年9月入住青岛市市立医院重症医学科的29例脓毒症患作为研究对象,根据28 d预后将患者分为存活组(20例)与死亡组(9例).收集患者入院时的基线资料[包括患者的性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、白细胞计数(WBC)、NLR、血红蛋白(Hb)、血小板计数(PLT)、C-反应蛋白(CRP)、总蛋白(TP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(Cr)、CD4^(+)T淋巴细胞计数]和入院1、3、7 d mHLA-DR水平,并计算入院3 d、7 d mHLA-DR表达率与入院1 d的差值,记为ΔH3、ΔH7.比较不同预后两组患者上述指标的差异.绘制受试者工作特征曲线(ROC曲线)评价mHLA-DR、NLR、CD4^(+)T淋巴细胞计数、SOFA评分及APACHEⅡ评分对脓毒症患者28 d死亡风险的预测价值.结果与存活组比较,死亡组APACHEⅡ评分、SOFA评分、NLR均明显升高,ΔH7、CD4^(+)T淋巴细胞计数均明显降低(均P<0.05).ROC曲线分析显示:ΔH7、NLR、CD4^(+)T淋巴细胞计数、SOFA评分及APACHEⅡ评分均对脓毒症患者28 d预后均有预测价值,ROC曲线下面积(AUC)和95%可信区间(95%CI)分别为0.817(0.635~0.999)、0.789(0.611~0.966)、0.786(0.588~0.985)、0.853(0.685~1.000)、0.844(0.659~1.000),均P<0.05.ΔH7联合NLR、ΔH7联合CD4^(+)T淋巴细胞、NLR联合CD4^(+)T淋巴细胞以及ΔH7、NLR、CD4^(+)T淋巴细胞3者联合检测对脓毒症患者28 d预后亦有预测价值,AUC和95%CI分别为0.867(0.735~0.998)、0.878(0.752~1.000)、0.883(0.760~1.000)、0.928(0.837~1.000),均P<0.05.结论脓毒症患者入院1 d NLR及CD4^(+)T淋巴细胞计数可预测脓毒症患者预后,动态监测脓毒症患者mHLA-DR水平同样可以预测脓毒症患者预后,然而7 d内单次测定mHLA-DR水平没有意义.就单指标而言,ΔH7在ΔH7、NLR、CD4^(+)T淋巴细胞计数3个指标中对于脓毒症患者预后的预测价值最佳,3个指标联合检测对脓毒症患者预后判断更具优势.
