Abstract
Longitudinal studies were carried out to determine trends in CD4 cell counts over a four year period in healthy HIV-negative adults in a rural (134 individuals) and an urban (80 individuals) site in Malawi, using TruCountTM and FACScountTM platforms. At baseline, median counts and 95% ranges were 890 (359-1954) cells per microlitre (μl) and 725 (114-1074) cells/μl respectively. 1.5% and 6% respectively had baseline counts below 350 cells/μl and 1.5% and 2.5% below 250 cells per μl. Transient dips to below 250 cells/μl were observed in seven individuals, with two individuals having persistently low CD4 counts over more than one year. Women and individuals from the urban site were significantly more likely to have “low CD4 count” (< 500 cells/μl) even when adjusted for other factors. In common with neighbouring countries, HIV-negative populations in Malawi have CD4 counts considerably lower than European reference ranges, and healthy individuals may have persistently or transiently low counts. Within Malawi, ranges differ according to the selected population.
Highlights
CD4+ lymphocyte (CD4) counts are routinely used world-wide, including many parts of sub-Saharan Africa, to determine eligibility for, and monitoring response to, antiretroviral therapy (ART) in HIV-positive patients
Well-established reference ranges from European and North American populations have proved inappropriate in some African populations in which the range of CD4 counts in apparently healthy HIV-negative individuals is significantly lower [1,2,3,4,5], this finding is not replicated in all settings [2, 6, 7]
The ranges of CD4 counts seen in these studies are similar to those from studies in Ethiopia, Central African Republic, Guinea Bissau and Botswana (Table 3) and are significantly lower than the those found in European populations [1]
Summary
CD4+ lymphocyte (CD4) counts are routinely used world-wide, including many parts of sub-Saharan Africa, to determine eligibility for, and monitoring response to, antiretroviral therapy (ART) in HIV-positive patients. They are used as a measure of the risk of development of opportunistic infections. In sub-Saharan Africa, the WHO recommend starting ART in Stage III disease if the CD4 count is
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