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The pattern of change over time of CD4-lymphocyte counts was investigated prospectively in 420 patients infected with HIV-1 (106 women, 314 men; mean age 34.9 [21-70] years) to assess its value in prognosticating progression to AIDS. Only those CD4-lymphocyte values were taken into account which had been measured in the asymptomatic stage of the HIV infection and before introduction of antiviral treatment. An average of 4.5 (range 3-10) measurements per person were available. Mean observation time was 2.4 years, the mean annual CD4-lymphocyte decrease was 48 cells/microliters. 121 patients (28.8%) had a fall in CD4-lymphocyte count which in the regression analysis significantly differed from zero. In this group there occurred 19 progressions to AIDS (15.7%), in contrast to only 20 (6.6%) in the 299 patients with a nonsignificant CD4 fall (P 900 cells/microliters), there was on average a steeper reduction in CD4-lymphocyte counts than when it was lower. This findings argues against a linear CD4 fall during the total period of observation. The annual CD4 fall, described with linear regression, is a prognostic criterion on its own for early recognition of those patients at a high risk of progression to AIDS while still in the asymptomatic stage of HIV infection.

Several CD4 lymphocyte enumeration methods have been developed to be used as alternatives to conventional flow cytometry. However, no consensus has been reached on which technique should be widely adopted. We introduce here a novel nonflow cytometric method, called CD4 Select, for enumeration of CD4 lymphocytes. Instead of using a flow cytometer, the method requires only an automatic hematoanalyzer (complete blood count [CBC] machine). The correlations of the percentage of CD4 lymphocytes and absolute CD4 counts with the CD4 Select method and standard flow cytometry were 0.932 and 0.922, respectively. The CD4 Select method yielded percentage of CD4 lymphocytes greater than flow cytometry by a mean of 0.06%, and the limits of agreement at 95% confidence interval (CI) were 9.46% to -9.56% using Bland-Altman analysis. The CD4 select method is cheap, valid, and simple enough to be conducted locally at small facilities. The method yields not only absolute CD4 lymphocytes, but also percentage of CD4 lymphocytes. The use of a hematoanalyzer also gives this method relatively high sample throughput and makes it less labor-intensive than other nonflow cytometric methods.

Summary CD4+ lymphocytes are a primary target of the human immunodeficiency virus (HIV), and CD4 counts are one of the factors used to measure disease progression in HIV-positive individuals. CD4 counts vary in uninfected individuals and across populations due to a variety of demographic, environmental, immunological and genetic factors that probably persist throughout the course of HIV infection. This study sought to determine reference levels and identify factors that influence lymphocyte counts in 681 HIV-uninfected adults in Senegal, where residents are exposed to a variety of infectious diseases and other conditions that may affect CD4 counts. Lymphocyte counts were assessed in commercial sex workers, symptomatic men and women presenting to the University of Dakar infectious disease clinic for out-patient care and women seeking family planning services. CD4 and CD3 lymphocyte counts differed between the four study groups (P

Background The global HIV/AIDS pandemic and guidelines for initiating anti-retroviral therapy (ART) and opportunistic infection prophylaxis demand affordable, reliable, and accurate CD4 testing. A simple innovative approach applicable to existing technology that has been successfully applied in resource-challenged settings, PanLeukogated CD4 (PLG), could offer solutions for cost saving and improved precision. Methods Day-old whole blood from 99 HIV+ donors was simultaneously studied in five North-American laboratories to compare the performance of their predicate methods with the dual-platform PLG method. The predicate technology included varying 4-color CD45/CD3/CD4/CD8 protocols on different flow cytometers. Each laboratory also assayed eight replicate specimens of day-old blood from 10 to 14 local donors. Bias and precision of predicate and PLG methods was studied between- and within-participating laboratories. Results Significantly (P < 0.0001) improved between-laboratory precision/coefficient of variation (CV%) was noted using the PLG method (overall median 9.3% vs. predicate median CV 13.1%). Within-laboratory precision was also significantly (P < 0.0001) better overall using PLG (median 4.6% vs. predicate median CV 6.2%) and in 3 of the 5 laboratories. PLG counts tended to be 11% smaller than predicate methods (P < 0.0001) for shipped (median of predicate—PLG = 31) and local specimens (median of predicate—PLG = 23), both overall and in 4 of 5 laboratories (median decreases of 4, 16, 20, and 21% in shipped specimens); the other laboratory had a median increase of 5%. Conclusion Laboratories using predicate CD4 methods similar to those in this study could improve their between-laboratory and their within-laboratory precision, and reduce costs, by switching to the PLG method after adequate training, if a change (usually, a decrease) in CD4 counts is acceptable to their health systems. © 2008 Clinical Cytometry Society

OBJECTIVE In Botswana, a 36-month course of isoniazid treatment of latent tuberculosis (TB) infection [isoniazid preventive therapy (IPT)] was superior to 6-month IPT in reducing TB and death in persons living with HIV (PLHIV), having positive tuberculin skin tests (TSTs) but not in those with negative TST. We examined the cost-effectiveness of IPT in Botswana, where antiretroviral therapy (ART) is widely available. DESIGN Using a decision-analytic model, we determined the incremental cost-effectiveness of strategies for reducing TB and death in 10,000 PLHIV over 36 months. METHODS IPT for 6 months and provision of ART if CD4 lymphocyte count

Non-hodgkin`s lymphoma (NHL) is the most common haematological malignancy which is seen in HIV infected patients. Among NHLs, immunoblastic lymphomas are most common and a majority of these are diffuse large B-cell lymphomas. Multiple myeloma is a disease of the elderly. It is extremely rare below 30 years of age. On the other hand, in HIV infected individuals, the average age of presentation with plasma cell disorders is 33 years, which is far younger than the average age of presentation in general population. The incidence of AIDS defining malignancies has declined markedly, whereas non-AIDS defining cancers are being increasingly diagnosed in patients with HIV infection during the HAART-era and they may be the presenting manifestations of AIDS. Multiple myeloma, however, usually is not a first presenting feature of AIDS. The usual clinical presentation of multiple myeloma is bone pain and pallor. Pancytopaenia is a rare presenting feature of multiple myeloma. Here, we are reporting a case of pancytopaenia which occurred in a 28-year-old, newly diagnosed, HIV-1 positive female, who with the help of bone marrow examination and further investigations, was subsequently diagnosed as multiple myeloma.

Since 1996 and the introduction of the highly active antiretroviral therapy (HAART), we observe an increasing life expectancy in persons living with HIV (PLHIV) worldwide with a changing in death profile causes. Concerning the HIV infection, the World Health Organization (WHO) recommends the use of HAART. However, some disparities exist between countries, because of treatment access and local recommendations. The WHO recommends to start HAART when CD4 lymphocyte count is under 500/mm3. No specific references exist for the cancer treatments in PLHIV, while this is a fragile population with morbidities requiring more attention.

A CD4 monoclonal antibody which reacts with CD4 + lymphocytes but does not react significantly with monocytes was generated and used to develop a simple method for CD4 count. In a comparison with standard flow cytometry, high correlation was obtained. The developed method can be an alternative to flow cytometry for resource-limited countries.

BACKGROUND The CD4 lymphocyte count had ethnic variability as observed in many studies. In populations with CD4 counts inherently lower than in the West, the Center for Disease Control and Prevention (CDC) classification system of HIV-infected individuals may not be appropriate. As there is no such criterion currently available for ethnic north Indians HIV-patients, we undertook this study to assess the applicability of the western case definition in north Indian HIV patients. METHODS The CD4 counts of 40 normal and 376 HIV-infected north Indian adults attending to ID clinic, SS hospital, Varanasi were estimated by flowcytometry. The mean CD4 counts were estimated and compared between CDC groups A, B and C and controls. Receiver operator characteristic (ROC) curves were generated to determine the cut-off that correlated best with clinical staging for this population. RESULTS For CDC groups A, B and C, the mean CD4 counts/mul (upper limits of the 95% CI) were 380.3, 249.2 and 120.9, while the mean CD4 levels in healthy volunteers was 818.4. CONCLUSION The mean CD4 count among normal north Indians is significantly lower than that in the western population and parallels that of the Chinese. When categorized based on the Center for Disease Control and Prevention (CDC) classification system, the mean CD4 counts in HIV-infected individuals was lower. Categories of CD4 counts >280, 120-280 and < or =120 cells/microl correlate better with disease progression among HIV-infected individuals. A longitudinal study is required before guidelines for the India population can be devised.

PURPOSE: To study the effect of antiretroviral drugs administered during pregnancy on CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women and on the anthropometric parameters of their neonates. METHODS: A prospective study was conducted on 57 pregnant women and their neonates divided into 3 groups: ZDV Group, HIV-infected mothers taking zidovudine (n = 20); triple therapy (TT) Group, mothers taking zidovudine + lamivudine + nelfinavir (n = 25), and Control Group, normal women (n = 12). CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women were analyzed during two periods of pregnancy. The perinatal prognosis took into account preterm rates, birth weight, intrauterine growth restriction, perinatal death, and vertical transmission of HIV-1. Data were analyzed statistically using the nonparametric chi-square, Mann-Whitney, Friedman, Kruskal-Wallis, and Wilcoxon matched pairs tests, with the level of significance set at P

Controversial data regarding the association between immunosuppression and prevalence/ severity of periodontal diseases in HIV infection have been reported. Thus, the aim of this study was to test the hypothesis that lower T CD4 lymphocyte levels are not related to a higher prevalence of chronic periodontitis in HIV-infected Brazilians undergoing highly active anti-retroviral therapy (HAART).Sixty-four HIV-infected patients under HAART were classified as having chronic periodontitis; i.e.,or = three sites with probing depth (PD) and/or clinical attachment level (CAL)or = 5 mm or periodontal healthy (no sites with PD3 mm and/or CAL4 mm). All subjects received conventional periodontal therapy. Bleeding on probing, plaque accumulation, PD, and CAL were registered at six sites/tooth at baseline and 4 months after therapy. Epidemiological features and levels of T CD4 lymphocytes were obtained from medical records. Significance of differences in periodontal clinical parameters within and between groups were determined using Wilcoxon signed-rank and Mann-Whitney or independent sample t tests. Associations between T CD4 levels and clinical parameters were determined using the chi square test.Sixty-one percent of the HIV-infected patients represented AIDS cases, although 69% of them were periodontally healthy. The overall T CD4 lymphocyte mean levels was 333 +/- 254 cells/mm3 and viral load was 12,815 +/- 24,607 copies/mm3. Yet the prevalence of chronic periodontitis was relatively low (36%). In addition, patients with periodontitis presented a moderate disease (mean PD = 2.2 +/- 0.10; mean CAL = 2.6 +/- 0.13) and responded successfully to periodontal therapy. These subjects showed higher levels of T CD4 cells, but lower counts of neutrophils than periodontally healthy patients. Among periodontally healthy and chronic periodontitis patients, 41.7% and 22.9%, respectively, had low levels of T CD4 lymphocytes. No significant differences between periodontal status and epidemiological and immunological parameters were observed.Based on these results, the hypothesis that lower T CD4 lymphocyte levels are not associated with higher prevalence of chronic periodontitis in HIV-infected Brazilians under HAART cannot be rejected.

OBJETIVO: Correlacionar a prevalência das doenças dermatológicas entre pacientes infectados pelo HIV com a contagem de linfócitos CD4. MÉTODOS: Estudo de série de casos realizado na região de Caxias do Sul, Estado do Rio Grande do Sul. Os dados foram coletados por meio da revisão de prontuários de pacientes com infecção pelo HIV internados em hospital público (198 pacientes, período de março de 1998 a junho de 2002) ou atendidos no ambulatório central universitário (40 pacientes, período de março a junho de 2002). As variáveis analisadas foram: idade, sexo, contagem de linfócitos CD4, carga viral e doenças dermatológicas apresentadas pelo paciente. Os testes estatísticos utilizados foram o Teste t de Student, o de Spearman e o do qui-quadrado. RESULTADOS: A freqüência de doença dermatológica foi de 67,2% entre os pacientes hospitalizados e de 75,0% entre os pacientes ambulatoriais. Candidíase oral foi a doença dermatológica mais prevalente. Na população hospitalar, a média de células CD4 foi menor entre os pacientes com doença dermatológica dos sem doença dermatológica (142,34 células/mm³ vs 512,35 células/mm³, respectivamente; p=0,018). O mesmo fenômeno foi observado na população ambulatorial (138,88 células/mm³ e 336,21 células/mm³, respectivamente; p=0,001). Verificou-se, em ambas as populações, uma correlação negativa entre a contagem de CD4 e o número total de doenças dermatológicas apresentadas pelo paciente (p=0,000, população hospitalar; p=0,000, população ambulatorial). CONCLUSÕES: As doenças dermatológicas são altamente prevalentes entre os pacientes infectados pelo HIV, sendo que a freqüência e o número dessas manifestações correlacionam-se bem com o status imunológico do paciente e com a progressão da doença.

Highly active antiretroviral therapy (HAART) initiated in advanced HIV disease is associated with CD4 lymphocyte increases (200-300 cells/ mm 3 after 2-4 years), although longer-term cellular dynamics have not been studied. We observed a significant median CD4 lymphocyte increase of 126 cells/mm 3 and 54 naive CD4 lymphocytes from year 3 to 6 of HAART among 20 individuals with pre-HAART CD4 cell counts of 100-300 cells/mm 3 . This cohort represents the longest prospective immunological follow-up of virologically suppressed patients on HAART.

Objectives To describe the prevalence and risk factors of poor CD4 count rise despite a good virological response on highly active antiretroviral treatment (HAART). Methods The patients from the EuroSIDA study who started HAART with a baseline CD4 count of

Objective To determine the CD4 lymphocyte counts in patients diagnosed with chronic periodontitis. Methods A total of eighty patients and twenty control subjects attending Central Hospital and University of Benin Teaching Hospital (UBTH), Nigeria were recruited for the study. Three millilitres of blood sample was collected from each subject, put into ethylene diaminetetra-acetic acid (EDTA) bottle and mixed thoroughly. CD4 cell counts were determined using the Cyflow SL-3 method. Results The results showed that subjects within the age of 51-60 years had the highest cases of periodontitis (32.5%). Females were more affected (61.25%) than the males (38.75%). Based on the CD4 counts among the subjects, 60 (75%) had greater than 700 cells/μL; 12 (15%) between 500-700 cells/μL and only 8(10%) had less than 500 cells/μL which showed that CD4 counts increased in the peripheral blood of the subjects. Conclusions The need to properly brush the teeth and encourage regular cleanings by the dentist is further encouragedc for the prevention of periodontal disease.

Human Immunodefficiency Virus (HIV) is a virus that decreases the human immunity system, therefore the infected people become susceptible to any kind of infections. Examination of CD4 lymphocyte count periodically is one of the antiretroviral therapy success indicators. The purpose of this research was to determine the difference of CD4 lymphocyte count before and after antiretroviral therapy at Ulin General Hospital Banjarmasin on 2013-2015. The method of this research was observational analytic with cross-sectional approach. The study population was 55 patients which were selected by inclusion and exclusion criteria. Results portrayed an increase of the CD4 lymphocyte count in 51 patients after being given four kinds of antiretroviral for 6 months with the mean increase in CD4 lymphocyte count was 92,72 cell/µL . Data analysis result with Wilcoxon test portrayed a difference of the CD4 lymphocyte count before and after antiretroviral therapy with p value=0,000. In conclusion, there was a significant difference of the CD4 lymphocyte count before and after antiretroviral therapy. Keywords : Human Immunodeficiency Virus, CD4, lymphocyt, antiretroviral therapy

Lues maligna is a rare severe cutaneous manifestation of secondary syphilis. It is also known as malignant syphilis and ulceronodular syphilis. We report a case of a 58-year-old HIV-infected male who presented with diffuse, pruritic, non-tender, maculo-papular skin lesions, ulcerated nodules and plaques surrounded by an erythematous base. The disseminated skin lesions were at various stages and were located on his back, chest, arms and testicles. Patient had been receiving antiretroviral therapy. Laboratory studies had demonstrated CD4 lymphocyte count of 463 cells/mm3 and an undetectable HIV viral load. Workup revealed a rapid plasma reagin of 1:256 dilutions and the skin biopsy findings were compatible with syphilis. The skin lesions resolved with intramuscular penicillin. We herein describe a rare case of lues maligna in an HIV-infected patient with a preserved immune function and viral suppression. Such skin lesions can mimic fungal or mycobacterial infections and can pose a diagnostic challenge. Even in the modern era, syphilis remains the great impostor. Clinicians must be able to recognize this condition based on clinical characteristics and risk factors to diagnose and treat this condition promptly.

Background: Since laboratory assessments of HIV-infected patients by flow cytometric methods are expensive and unavailable in resource-limited countries, total lymphocyte count by haematology cell counter is supposed to be a suitable surrogate marker to initiate and monitor course of the disease in these patients. The aim of this study was to evaluate the utility of total lymphocyte count as a surrogate marker for CD4 count in HIV-infected patients. Patients and Methods: In a prospective study 560 HIV-positive individuals evaluated for total and CD4 lymphocyte count. For correlation between CD4 count and total lymphocyte count, haemoglobin and haematocrit we defined cut-off values as 200 cell/μl, 1200 cell/μl, 12 gr/dl and 30%, respectively, and compared CD4 count with each parameter separately. Positive predictive value, negative predictive value, sensitivity and specificity of varying total lymphocyte count cutoffs were computed for CD4 count ≤ 200 cell/μl and ≤ 350 cell/μl. Results: Strong degree of correlation was noted between CD4 and total lymphocyte count (r: 0.610, P < 0.001). Mean and standard deviation of total lymphocyte count, haemoglobin and haematocrit in relation to CD4 count were calculated which indicated significant correlation between these variables. Kappa coefficient for agreement was also calculated which showed fair correlation between CD4 200 cell/μl and total lymphocyte count 1200 cell/μl ( 0.35). Conclusion: This study reveals that despite low sensitivity and specificity of total lymphocyte count as a surrogate marker for CD4, total lymphocyte count is of great importance and benefit in resource-limited settings.

Background: This study assessed the seroprevalence of Helicobacter pylori antibodies among Iranian patients with human immunodeficiency virus (HIV) infection. It also examines whether anti H. pylori seroprevalence was associated with the severity of the HIV infection or the antiretroviral treatment. Material and Methods: A total of 114 HIV-infected patients and 114 age and sex-matched controls, without symptoms referable to upper gastrointestinal tract were recruited. Blood samples were obtained from all subjects. Serum IgG and IgA against H. pylori measured using the enzyme-linked immunosorbent assay (ELISA). Results: The rate of anti H. pylori IgG seropositivity was 57.9% in HIV-infected patients and 28.95% in controls (P < 0.001), while the rate of IgA seropositivity was 2.64% in HIV patients and 31.57% in controls (P < 0.001). Although there was an increasing trend of higher IgG and IgA titre by increasing CD4 cell count in HIV-positive patients, it was not reach statistical significance. There was no statistical difference in the serology of anti H. pylori IgG and IgA between patients receiving antiretroviral therapy comparing untreated HIV patients. Conclusions: This study showed higher seroprevalence of H. pylori IgG along with lower seroprevalence of H. pylori IgA in HIV-positive patients compared matched controls.Keywords: H. pylori, HIV, Seroprevalence, IgG, IgA

Introduction: AIDS is a disease of human immune system caused by Human Immunodeficiency Virus. Immunologically it is defined as the condition characterized by CD4 cell count less than 200 cells/mm3. In developing countries the resource are limited so that CD4 count is not easily available in every parts of the country and is too expensive to afford. The Total lymphocyte count (TLC) has been found to be an inexpensive and useful surrogate marker of CD4 count for staging disease, timing of initiation of Antiretroviral Therapy (ART) and response to ART. Objective: To study the relationship between the T-cell subsets (CD3 and CD4) in HIV patient and to evaluate TLC as a surrogate marker of CD4 T-cell count. Methods: A total of 303 samples were evaluated from July 2010 to September 2010 at NPHL for this study. The blood sample were analyzed by FACS count and the result were analyzed by SPSS 16.0 to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) to find out the relationship between the T cells subsets and evaluate TLC as a surrogate marker of CD4 T cell count for the diagnosis of CD4 count

Background: Assessment of patients prior to cytotoxic chemotherapy usually includes absolute neutrophils count. Other cellular markers of susceptibility to infection as well as immunocompetence include the T Helper lymphocyte count. In cancer patients, decrease in these lymphocytes has been observed to be associated with decreased overall survival. Aim: To assess the degree of CD4 lymphopenia encountered during cytotoxic chemotherapeutic treatment for cancer and evaluate the differences observed for the various drug combinations. Subjects and Methods: Eighty patients with various histologically diagnosed malignancies had their CD4 lymphocyte counts carried out at days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed with breast cancer 36/80 cases (45%), non‑Hodgkin’s lymphoma 8/80 cases (10%), Hodgkin’s lymphoma 13/80 cases (16.3%), multiple myeloma 7/80 cases (8.8%), colorectal carcinoma 6/80 cases (7.5%), and other malignancies 10/80 cases (12.5%). CD4 lymphocyte count was done using the Partec Cyflow® 2000 CD4 cell counter, and their socio‑demographic data of the patients were assessed using a questionnaire. Results: The mean (sd) CD4 lymphocyte count pre‑ and post‑chemotherapy was observed to be 567 (341) cells/μLand 349 (207) cells/μL while the median values were 454 cells/μLand 349 cells/μL respectively. There were significant differences in CD4 lymphocyte counts after chemotherapy compared to the pre‑chemotherapy values. Conclusion: Epirubicin combinations used in breast cancer patients as well as (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) ABVD regimen used in treatment of Hodgkin’s lymphoma were found to be significantly less lymphotoxic than other chemotherapeutic combinations. These drugs or their combinations may be less immunotoxic than other known regimen used for these malignancies.

Peripheral CD4 T-cell depletion has been observed in human immunodeficiency virus (HIV)-negative patients with pulmonary tuberculosis (TB). To investigate more accurately this alteration, we studied peripheral blood CD45RA+ and CD29high CD4 subsets in 79 TB patients with (HIV+TB+) or without (HIV−TB+) HIV infection, 85 HIV-infected patients without TB (HIV+TB−), and 43 healthy controls, all living in West Africa. The high proportion of CD4+CD29high T cells observed in controls was dramatically decreased in CDC-A stage HIV+TB− patients. CD45RA+ CD4+ T cells were depleted during the CDC-B stage. Both the percentage and the absolute count of CD29highCD4+ T cells were decreased in HIV−TB+ and HIV+TB+ patients versus controls, but CD45RA+CD4+ T cells were not decreased in TB patients without HIV-infection. Although distinct alterations in the CD4+ T-cell homeostasis are involved in TB- versus HIV-infected subjects, our data suggest that the CD29+CD4+ T-cell depletion observed during the early HIV disease contributes to the risk of active TB, by reducing the pool of T cells able to relocalize to the sites of the M. tuberculosis multiplication.

OBJECTIVES To determine interrater variability in classifying cervical biopsies from women with human immunodeficiency virus (HIV). MATERIALS AND METHODS Cervical biopsies performed on women participating in the Women's Interagency HIV Study (WIHS) were read at the six participating sites. A 10% random sample was retrieved and reviewed using standardized terminology by pathologists with a special interest in gynecologic pathology. Results were compared with kappa values and Mantel-Haentzel tests. RESULTS Biopsies from 288 HIV-seropositive and 24 HIV-seronegative women were reviewed. The weighted kappa value of 0.67 indicated moderate to strong agreement between original and review diagnoses, with a range of 0.54 to 0.84 across sites. No cancers were identified. Significantly more specimens showing cervical intraepithelial neoplasia (CIN) grade 2 or 3 were identified by review pathologists (p = .02). CIN2 or CIN3 was graded less severely by local pathologists in 18 (51%) of 35 cases, all from HIV-seropositive women. Local pathologists' diagnoses of CIN2 or CIN3 were downgraded by reviewers in 4 of 21 cases (19%). Discrepancies were more common among women with lower CD4 lymphocyte counts. CONCLUSIONS Although discrepancies occur, interrater correlation in the interpretation of cervical biopsies from women with HIV is moderate to strong.

Cytomegalovirus-stimulated CD4+lymphocytes from seropositive but not seronegative donors suppressed viral gene expression in primary human astrocytes. This suppressive activity was mediated through soluble factors. These findings suggest that CD4+lymphocytes play a role in defense of the brain against cytomegalovirus.

Progressive multifocal leukoencephalopathy (PML) is a rare and usually fatal demyelinating disorder. Reactivation of latent JC virus infection is the causative agent [1]. PML usually occurs as a la...

The effects of cessation of i.v. drug use on CD4 lymphocyte count and serum levels of beta2 -microglobulin (beta2 m) and soluble interleukin-2 receptor (sIL-2R) were prospectively investigated in 41 HIV-positive drug users enrolled in a methadone treatment programme. Fifteen HIV-positive matched non-abstainers served as controls. During the follow-up of 12 months the mean CD4 lymphocyte count remained unchanged in the methadone-treated group but fell significantly in controls. beta2 m and sIL-2R values decreased in abstainers at the beginning of the treatment but rose in non-abstaining group. We conclude that cessation of illicit drug abuse and methadone treatment in HIV-infected injecting drug users may exert a beneficial effect on the immune status.

Objective: We tested the hypothesis that 5 months of combined anti-retroviral therapy (cART) affect cortical sources of resting state cortical electroencephalographic (EEG) rhythms in naive HIV subjects. Methods: Eyes-closed resting state EEG data were recorded at baseline (i.e. pre-treatment; T0), T1 (after 4 weeks of cART), T2 (after 8 weeks of cART), and T5 (after 5 months of cART) in 38 naive HIV subjects. EEG data were also recorded in 40 age-matched cognitively normal subjects for control purposes. EEG rhythms of interest were delta (2–4 Hz), theta (4–8 Hz), alpha 1 (8–10.5 Hz), alpha 2 (10.5–13 Hz), beta 1 (13–20 Hz), and beta 2 (20–30 Hz). Cortical EEG sources were estimated by LORETA software. Results: Compared to the control group, the HIV group at T0 showed greater delta sources and lower widespread alpha sources. cART induced a global improvement of biological (viral load, CD4 count) and EEG (delta, alpha) markers, remarkable even after 4 weeks. Compared to HIV Responders (>100 cells/ll at 5-month follow up), the HIV Mild Responders (

SETTING: Benin where 20 of 54 tuberculosis (TB) clinics caring for 80% of all TB patients began providing integrated human immunodeficiency virus (HIV) care in 2005. OBJECTIVE: To describe the characteristics and TB treatment outcomes of the first cohorts of TB-HIV patients and to assess programmatic outcomes. METHODS: Retrospective cohort study using data from the TB register and the register of co-infected patients. RESULTS: During the study period 8368 TB patients were registered 7787 (93%) were tested for HIV and 1255 (16%) were HIV-positive including 385 (32%) who already knew their positive status. Most patients (88%) were tested within 15 days of TB diagnosis. Female and young patients were overrepresented among the co-infected. Cotrimoxazole preventive therapy was administered to 1152 patients (95%) during anti-tuberculosis treatment and antiretroviral treatment (ART) to 469 (42%). The likelihood of receiving ART increased as initial CD4 lymphocyte counts decreased. Fifteen per cent of TB-HIV patients died during anti-tuberculosis treatment. Patients already on ART prior to anti-tuberculosis treatment experienced the worst outcomes. Patients who initiated ART early during anti-tuberculosis treatment or in the timeframe recommended by the guidelines fared the best. CONCLUSION: HIV care has been successfully and sustainably integrated into TB services in Benin. However ensuring the access of co-infected patients to more favourable treatment outcomes still represents significant challenges.

The Sindh AIDS Control Program (SACP) in Pakistan began dispensing combination antiretroviral therapy (ART) in May 2006 in Karachi. This study aimed to assess the management and outcomes of ART-treated patients. Data were extracted from medical records of adult patients registered with the SACP who received ART between May 2006 and May 2010. In total, 300 patients received ART, of whom 77.7% were men. The median CD4 cell count at the time of joining the SACP was 130 cells/mm(3). ART was nevirapine-based in 69.1% of cases and was correctly prescribed in 97.3%. Of 257 patients who received ≥1 month of ART,90% were regular with their medications and appointments. Of the 300 patients, 70 (23.3%) had HIV-related deaths and 4 (1.3%) had non-HIV-related deaths, whereas 32 (10.7%) transferred out and 16 (5.3%) stopped attending the clinic and could not be traced. Estimated survival in the first 6 months stratified by initial CD4 lymphocyte count ≥50 cells/mm(3) and50 cells/mm(3) was 85.8% (95% CI 80.8-90.0%) and 52.2% (95% CI 40.9-63.1%), respectively. Viral suppression was achieved in 95.4% of those who survived beyond 3 months of starting ART. ART can be managed adequately with excellent patient adherence and satisfactory clinical outcomes in a resource-limited setting.

Objective. To assess the radiographic features in patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis (PTB), and the association with CD4 lymphocyte count and sputum smear. Method. A prospective study was carried out on 89 HIV positive patients with PTB. The demographics, smoking history, sputum smear result, chest radiographic findings and CD4 lymphocyte count were documented. Results. Out of the 89 patients recruited in the study, 41 were males and 48 were females. Eighteen (18) patients had typical radiographic features, 60 patients had atypical radiographic features while only 11 of them had normal radiographic films. Sixty eight (68) patients had CD4 count200 cells/mm(3), 19 patients had CD4 count between 200-499 cells/mm(3), while only 2 patients had CD4 count from 500 cells/mm(3) upwards. The association between low CD4 count and radiographic finding was statistically significant, (P value0.05). Sixty (60) patients had negative sputum smear for Acid and Alcohol Fast Bacilli (AAFB), while the remaining 29 patients had positive smear. The association between low CD4 count and negative smear was statistically significant (P value0.05). Conclusion. The radiographic pattern and the result of the sputum smear for AAFB has a significant relationship and association with the immune status of patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis.

Summary:It is widely assumed that the time since human immunodeficiency virus (HIV) infection is an important indicator of HIV disease stage, yet for most infected individuals the date of infection is unknown. We consider whether marker values, such as CD4 lymphocyte number or percent and levels of

Zusammenfassung. Aus der Sicht 40jahriger Erfahrung auf dem Gebiet der medizinischen Mykologie wird anhand folgender aktueller Themen zur Zustandigkeit des medizinischen Mykologen bei der Beurteilung von Pilzen im Wohn- und Krankenhausmilieu Stellung genommen: 1. Der HIV-Infizierte und das Cr.-neoformans-Biotop; die Disposition fur die Cryptococcose in Abhangigkeit von der CD4-Lymphozytenzahl. 2. Invasive Aspergillose nach Herztransplantation; durch enge Zusammenarbeit von Herzchirurg und medizinischem Mykologen wurde gezeigt, das die gefurchtete invasive Aspergillose nach Herztransplantation verhindert werden kann. 3. Bioabfall und Kompost als derzeit aktuelle Pilzbiotope im Wohnbereich. Auf das mogliche Vorkommen der verschiedenen Pilze in Bioabfall, darunter auch Erreger von Systemmykosen, wird aufmerksam gemacht. Summary. From the viewpoint of 40 years of experience in the field of medical mycology with the help of current topics the competence of the medical mycologist for evaluation of a presence of fungi in the home and hospital environment is commented. The topics considered are as follows: 1. The HIV-infected person and the habitat of Cr. neoformans; the predisposition for cryptococcosis and the CD4 lymphocyte count. 2. Invasive aspergillosis after heart transplantation; by exemplary cooperation between the heart surgeon and the medical mycologist it could be demonstrated that the frequently fatal invasive aspergillosis can be avoided. 3. Attention is drawn to the currently most interesting habitats of fungi in the home environment, i.e., biological waste and compost. It has been shown that among the various fungi, the causative agents of systemic mycoses may also be found.

Standard methods for determining absolute CD3+CD4+ T-lymphocyte concentrations using combined results from flow cytometry and hematology analyzers are expensive and require fresh (< 18 h old) blood. We evaluated four new "alternative" methods for determining absolute CD4+ T-lymphocyte counts; (a) the FACSCount System (Becton Dickinson Immunocytometry Systems), (b) VCS Technology/Coulter Cyto-Spheres (Coulter Corporation), (c) Zymmune CD4/CD8 Cell Monitoring Kit (Zynaxis, Inc.), and (d) TRAx CD4 Test Kit (T Cell Diagnostics). EDTA-anticoagulated whole-blood specimens from HIV-seropositive patients and anti-HIV-negative adult blood donors and staff were tested by the standard flow cytometry method on fresh blood (0-6 postphlebotomy) and by the four alternative methods at 0 to 6 h and 24 to 30 h postphlebotomy. Representative specimens (< 6 h old) were tested five times with each system to evaluate reproducibility. Correlation coefficients for absolute CD4+ counts between standard flow cytometry and the alternative methods ranged from 0.84 to 0.92 for both fresh and 24- to 30-h-old specimens. Average coefficient of variation for reproducibility ranged from 4.5 to 7.1%. The four alternative CD4+ T-lymphocyte counting methods performed well relative to standard methods. Each alternative method offers advantages over standard flow cytometry with respect to sample throughout, required technical expertise, and cost per result. These methods should facilitate wider availability of low-cost CD4 counts.

The Ortho CytoronAbsolute is a flow cytometer designed to provide direct absolute counts of lymphocytes and their subsets from a single instrument. This study was designed to determine the performance of four geographically separated CytoronAbsolute instruments using 24-h-old, shipped, whole blood samples and to compare the results obtained on the CytoronAbsolute to those obtained using combinations of hematology instruments and other flow cytometers. The absolute count feature of the CytoronAbsolutes located at the four sites were cross calibrated and gave across-site coefficients of variation (CVs) of4.0% for absolute count and 8.2% for absolute lymphocyte count. The calibration was stable for at least 2 months. Absolute lymphocyte counts and lymphocyte percentage immunophenotypes were determined on blood from 50 healthy human immunodeficiency virus (HIV)-seronegative donors. There were no significant site-to-site differences (each P.05) in CD3+/CD4+ absolute lymphocyte counts determined on the CytoronAbsolute. In contrast, there was a significant site-to-site difference (P.001) between sites 2 and 3 and sites 3 and 4 in the absolute CD3+/CD4+ lymphocyte counts determined via the conventional method of combining a flow cytometry-derived percentage with a hematology instrument-derived lymphocyte count. There was no significant difference (P = .388) in CD3+/CD4+ lymphocyte percent determinations between the CytoronAbsolute and the FACScan or Profile II flow cytometers used in this study. These results demonstrate that different operators can cross calibrate CytoronAbsolutes for absolute CD3+/CD4+ lymphocyte subset determinations, even over large geographic distances.

Summary Forty-seven HIV-infected haemophilic patients were entered into a hepatitis A vaccination programme. 10 patients (21%) were lgG seropositive for hepatitis A consistent with past exposure. Of the 37 patients offered vaccination, one refused and 31 completed the vaccination course, 17/13 (55%) seroconverted, nine after the second and eight after the third injection, and 14 patients failed to seroconvert. The CD4 lymphocyte counts immediately prior to vaccination were significantly higher in the patients who developed immunity compared to the nonresponders (median CD4 count in the immune group 380 × 106/1 (range 170–1290), median CD4 count in nonimmune group 110 × 106/1 (range 10–590), P== 0.003). No patient with a CD4 count < 170 × 106/1 seroconverted and five patients with well-preserved CD4 counts also failed to seroconvert. We conclude that HIV-infected haemophilic patients, especially those with more advanced disease, have an impaired response to hepatitis A vaccination. Due to the likely failure of response in patients with CD4 counts < 150 × 106/1, it is reasonable not to include these patients in a hepatitis A vaccination programme.

The authors administered the Medical Outcomes Study (MOS 20) Short Form Health Survey to 369 persons with HIV disease. The MOS survey measures six domains of health: physical function, role function, social function, mental health, health perception, and pain. Additional data included sociodemographics, HIV risk group, time since HIV diagnosis, symptoms (dyspnea, diarrhea, fever, chills, sweats, weight loss, weakness, numbness, memory trouble, seizures), and CD4 lymphocyte count within 3 months of the MOS survey. Bivariate analyses revealed worse MOS scores associated with older age in five health domains: physical function ( p < .01), health perception (p < .10), role function (n.s.), social function (n.s.), and mental health (n.s.). Older subjects reported less pain. When controlling for CD4 count and for sociodemographic and clinical variables, older age was significantly (p

Summary Twenty-six haemophilic patients with advanced HIV infection who had developed resistance or intolerance to zidovudine were treated with didanosine (ddI). 11 patients continue to take ddI at a median time of 14 months from commencement (range 7–18 months). Five of these patients showed an increase in CD4 lymphocyte count, reaching a maximum at a median time of 4 months. Four patients with HIV-related symptoms improved clinically. In general, the CD4 count and clinical improvements were not sustained. 11 patients discontinued ddI after a median of 3 months (range 3 days to 10 months), most commonly due to gastrointestinal side-effects. No case of pancreatitis or peripheral neuropathy was seen. Six patients, all with very advanced HIV disease, died. HIV-infected haemophilic patients who become resistant or intolerant to zidovudine may derive benefit from ddI, although this is usually transient.

Autoimmune disorders such as vitiligo have been previously reported in patients with human immunodeficiency virus (HIV) infection. We describe a case of vitiligo in association with HIV where a rising CD4 lymphocyte count due to highly active antiretroviral therapy (HAART) closely correlated with changes in the skin. This effect, to our knowledge, has not been previously observed.

We describe the CD4 lymphocyte count at HIV presentation in an HIV cohort from a rural district of India. The majority of patients were diagnosed for their HIV-related symptoms, although a sizeable proportion of women were diagnosed because of antenatal screening or for having an HIV-positive partner. Patients diagnosed of HIV for antenatal screening or having an HIV-positive sexual partner had higher CD4 lymphocyte count than patients having tuberculosis or HIV-related symptoms. The proportion of patients diagnosed with CD4 count 3were 46% and 68.7%, respectively, and these figures did not change during the five years of the study. Factors associated with late presentations were male sex, older age, not having a permanent house, and, in women, lower education and being a widow or separated. With the implementation of 2010 WHO guidelines, the number of newly diagnosed patients who will require HIV treatment will increase 13.8%. If the CD4 count threshold for initiating HIV treatment is increased from 350 to 500 cells/mm3, the number of patients in need of treatment would increase 15.7%. Therefore, new strategies for avoiding HIV late presentation are urgently needed in developing countries.

Enumeration of CD4 lymphocytes is essential for the clinical management of HIV-infected patients, but it can be difficult to afford in developing countries. In this study we evaluated a reagent reduction strategy for reducing the cost of enumerating CD4 cell absolute count and percentage using the FACSCalibur flow cytometer (Becton Dickinson). We compared the protocol recommended by the manufacturer with a protocol that used half of the usual amount of CD3/CD4/CD45 monoclonal antibody reagent in 100 samples from HIV-infected patients in a rural hospital in India. The concordance correlation coefficient between the two protocols was 0.976 for CD4 cell count and 0.984 for CD4 cell percentage. We did not find significant bias when performing Deming regression or Bland-Altman analysis. Sensitivity and specificity were 97% and 98.5% for identifying patients with less than 200 CD4 cells/μL, 98.1% and 93.8% for identifying patients with less than 350 CD4 cells/μL, and 100% and 94.7% for identifying patients with less than 25% CD4 cells, respectively. This reagent reduction strategy can be used for reducing the cost of enumerating CD4 lymphocytes in high-volume laboratories from resource-limited settings.

There is significant need for rapid yet reliable evaluation of promising new interventions for the treatment of patients with cancer or HIV infection. Considerable attention has been given to identifying replacement or 'surrogate' endpoints for the true clinical efficacy endpoints, in order to reduce the cost, size and duration of clinical trials. We discuss issues which affect the validity of surrogate markers. The reliability of the CD4 lymphocyte count marker is carefully considered in clinical trials of anti-retroviral agents in HIV infected individuals. The nature of surrogate markers and their reliability is discussed in cancer prevention, screening and treatment trials. Some suggested uses of marker information are also considered.

OBJECTIVE Description of the relationship between repeated measurements of CD4 lymphocyte count and development of AIDS in asymptomatic HIV-infected patients. DESIGN Repeated measurements of CD4 lymphocyte counts over an AIDS-free period in asymptomatic HIV-infected patients, and follow-up of the cohort to record subsequent clinical progression to AIDS. METHODS The cohort was studied in a double-blind randomized clinical trial. CD4 lymphocyte counts were measured on three occasions over 8 months in 851 patients. RESULTS Eighty subsequent clinical progressions to AIDS were recorded during a median follow-up period of 15.3 months. Each of the three measurements of CD4 lymphocyte count were separately predictive of subsequent progression to AIDS. However, when the three measurements were included simultaneously in a predictive model only the last measurement showed a significant predictive value. Change in individual CD4 count was also related to the risk of developing AIDS, but was no longer significant when the most recent measurement was included in the model. CONCLUSION These results indicate the closeness of the relationship between the actual state of the immune system and subsequent progression to AIDS.