CD4 Values Research Articles

Impact of aerobic exercises on selected inflammatory markers and immune system response among patients with sickle cell anemia in asymptomatic steady state.

Sickle cell anemia (SCA) is well recognized as a chronic inflammatory disease. Despite progress in therapy, SCA remains a cause of significant morbidity and mortality. The relationship between exercise and immune function has been of great interest to the scientific community and the lay public. The aim of this study was to measure the impact of aerobic exercise training on the immunologic parameters and inflammatory cytokines of patients with sickle cell anemia (SCA) in asymptomatic steady state. Sixty asymptomatic sickle cell anemia patients were involved in this study, their age ranged from 25- 40 years and were assigned to two sub-groups; group (A) received aerobic exercise training for 12 weeks, however group (B) received no training intervention for 12 weeks. Parameters of CD3, CD4 and CD8 were quantified, Leukocyte, differential counts, IL-6 and TNF-α were measured before and after 12 weeks, at the end of the study. The mean values of CD3, CD4 and CD8, leukocyte, monocytes counts, IL-6 and TNF-α were significantly decreased in group (A), while group (B) showed non-significant changes in these parameters. Also; there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment. The current study provides evidence that aerobic exercise training improves inflammatory markers and immune system in patients with sickle cell anemia (SCA) in asymptomatic steady state.

PERAN KOMISI PENANGGULANGAN AIDS DAERAH (KPAD) DALAM PENANGGULANGAN HIV DAN AIDS DI KABUPATEN KOTAWARINGIN TIMUR

Response to HIV and AIDS requires a approaches by the parties mutually integrated. Regional AIDS Commissions (KPAD) has a crucial role in the response to HIV and AIDS. This study aimed todescribe the role of KPAD well as some of the factors inhibiting the implementation of the HIV and AIDS in East Kotawaringin. Used qualitative methods to conduct a document review and in-depth interviews with all fi ve informants which is representative of several agencies that have links to the eff orts to combatHIV and AIDS, with purposive sampling method. The Results were analyzed by means of reduction, presentation, and verifi cation of data. Results showed reduction carried through socialization andeducation about HIV and AIDS in the various elements of society, the establishment of working group of the Pal 12, formed the group “Concerned citizens of AIDS” as well as the ARV (Antiretroviral) services is not limited to a minimum value of CD4. The results showed that KPAD role in response to HIV and AIDS can not be implemented to the fullest, this is due to several obstacles, namely the existence of localization is an determinant spread of cases, the unavailability of services and ARV in all health centers, the lack of cross-sectoral cooperation, fi nancial support from the government is minimal, and the lack of HIV and AIDS Regional Regulation (Perda).Keywords: Response to HIV and AIDS, AIDS Prevention and Control Commission (KPAD)

Emphysema in HIV Positive Patient: Diagnostic and Therapeutic Conduct

The increase of cases of patients with chronic obstructive pulmonary disease in HIV positive patients is a reality since the TAAE era. In its beginning, infectious respiratory diseases were the most frequent and prevalent. Different factors were associated to this entity such as the HIV virus itself, antiretroviral treatment, tobacco habit, the use of marijuana, anemia, coinfection with HCV, BMI, nadir and current value of CD4 and viral load. The control of the patient through dyspnea assessment scales and complementary studies such as spirometry, chest CT, 6- minute walk test and carbon dioxide diffusion test have provided tools to contribute to the diagnosis, treatment and prevention of the complications inherent in COPD. Our patient presented a severe respiratory obstruction with FCV less than 70%, FEV1 less than 80%, FEV1/CFV ratio less than 70%, diffusion test less than 80% and central emphysema and paralobulillar CT. Its CD4 values and viral load within normal parameters.

Sociodemographic and Anthropometric Profile of Positive HIV Patients in Early Traditional Treatment: Case of the Bonkoko Center

Context: In the Democratic Republic of Congo (DRC), the Antiretroviral (ART) drug coverage is still very low throughout the country. Hence, a large number of People Living with HIV (PLHIV) use traditional treatment made from plants to fight the HIV infection and the opportunistic infection associated to it. Objective: The objective of this work was to evaluate the clinical parameters; para clinical and socio-demographic studies at the beginning of treatment of People Living with HIV (PLHIV) who adhere to traditional treatment in Kinshasa. Methods: A cohort study was conducted in the Bonkoko center with a baseline of 3 months; 97 HIV positive patients were included randomly according to the specific inclusion criteria from January 11, 2016 to April 11, 2016. Clinical, biological and socio-demographic parameters were recorded in all patients at baseline. Results: A total of 97 patients were selected for the job. A total of 79 women (81%) and 18 men (19%) participated voluntarily. The mean age was 40.8 ± 10 years and the most represented age range was 36 - 45 years. The mean Body Mass Index (BMI) is 23.07 ± 3.8 at baseline. The married dominated the sample while the dominant religion was the other religions called revival. The level of study that dominated the population was the secondary level. The mean biological values at baseline were as follows: Glycaemia 85 ± 19 mg/dl; Urea 22.5 ± 6.66 mg/dl; Creatinine 0.88 ± 0.22 mg/dl; Total cholesterol 169.6 ± 37.7 mg/dl; HDL 52.6 ± 15.1 mg/dl; LDL 96.4 ± 31.4 mg/dl; Triglyceride 102.8 ± 47 mg/dl; SGPT 23.3 ± 11.1 UI/L; SGOT 22.3 ± 10 UI/L; Amylase 81.9 ± 31.1 UI/L; and the median values for CD4 was 220 cells/ml and for the Viral Load was 4.10 log10 copies of RNA/ml. Conclusion: This study showed that patients who adhere to traditional medicine for the treatment of HIV infection are not different from those starting Antiretroviral into modern centers. The patient is in search of wellness and what is better. These patients followed by Traditional Medicine must be considered and taken care of in an integral way like all PLHIV followed by modern medicine.

Study of T CD4 Lymphocytes by Flow Cytometry in Chronic Kidney Disease Patients in Abidjan

Objective: We undertook this study to analyze the T CD4 subset of non-HIV CKD patients and to investigate factors that may influence their rate. Materials and methods: It was a cross-sectional, three-month study, on the determination of T CD4, count by Flow Cytometry (FACS Calibur), in patients aged 18 to 65 years, chronic kidney disease according to KDOQI and non-HIV. Results: Sixty-three cases were collected with an average age of 41 years and sex ratio of 1.79. The median BMI was 22.9 kg/m2 and 69.9% had normal weight. 36 of patients (69.2%) were at stage 5 of chronic kidney disease. CD4 rate was low in 23 patients (36.5%), normal in 37 patients (58.7%) and high in 3 patients (4.8). There was a significant correlation between the decrease in absolute CD4 rate and the grade of chronic kidney failure (CKD) (p=0.02). In linear regression, a statistically significant correlation was observed between changes in absolute CD4 values and white blood cell level (p=0.000003), total lymphocyte rate (p=0,0006) and urea rate (p=0.04); on the other hand between changes in the absolute values of CD3 and the levels of white blood cells (p=0.000001) and lymphocytes rate (p=0.000002). Conclusion: The decrease in GFR is accompanied by a decrease in CD4 rate, which increases the risk of infections. This situation could contribute significantly to the morbidity and mortality of chronic kidney disease patients.

External evaluation of the quality of CD4 T cells enumeration in the laboratory of immunology and hematology at the Cocody University Hospital Center

IntroductionLe taux de lymphocytes T-CD4 (LT4) est un paramètre crucial de suivi et de décision thérapeutique au cours de l'infection au Virus de l'Immunodéficience Humaine (VIH). Sa détermination doit être fiable et précise. Pour fournir des résultats de qualité, le laboratoire d'immunologie et hématologie du Centre Hospitalier et Universitaire (CHU) de Cocody participe à l'Evaluation Externe de la Qualité (EEQ) de la numération des LT4 du QASI (Quality Assessment and Standardization for Immunological Measures relevant to HIV/AIDS). L'objectif de notre travail était d'évaluer la performance du laboratoire dans la numération des LT4.MéthodesUne étude rétrospective a été menée sur les rapports de performance d'EEQ du laboratoire. Les indicateurs de performances SDI (indice de déviation standard), CV (coefficient de variation) ont été évalués.RésultatsLe taux de participation au programme était de 83,33%. Les indicateurs de performance étaient satisfaisants. Les SDI étaient en majorité inclus dans l'intervalle de confiance [-2; +2]. Les CV des échantillons de valeurs normales de CD4 étaient dans les normes. Les taux de conformité des résultats CD4 rendus étaient respectivement de 89,58% et 91,87% pour le compte absolu et le compte relatif. Seuls les CV des échantillons de faible taux de CD4 étaient au-delà des normes (> 15%).ConclusionL'EEQ était un outil indispensable qui permettait au laboratoire de surveiller la qualité de ses analyses. Toutefois des mesures correctives devraient être renforcées dans le suivi-évaluation pour pérenniser et améliorer la qualité des analyses.

Inflammatory cytokines and immune system response to weight reduction in obese patients with type 2 diabetes mellitus

Introduction:Systemic inflammation and activated immune system response are common features in obese patients with non-insulin dependent diabetes mellitus (NIDDM) as obesity-induced NIDDM represents a burden for healthcare systems worldwide. However, there is a strong association between BMI and the human immune system and systemic inflammation among obese patients with NIDDM.Material and Methods:Eighty obese patients with NIDDM participated in this study, their age ranged from 41-52 years and their BMI ranged from 31-36 kg/m2. All Subjects were included in two groups: The first group received life style modification in the form of treadmill aerobic exercises in addition to diet control where, the second group received no therapeutic intervention. Parameters of CD4 and CD8 cells count were quantified, IL-6, TNF-α, leptin and body mass index (BMI) were measured before and after 3 months at the end of the study.Results:The mean values of CD4 and CD8 cells count were significantly increased, where mean values of TNF-α, IL-6, IL-8 and body mass index (BMI) were significantly decreased in group (A). While group (B) showed non-significant changes in these parameters. Also; there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study.Conclusions:Within the limit of this study, life style modification modulates systemic inflammation and immunological parameters among obese patients with NIDDM.Objecttive:This study aimed to examine effects of weight reducing program on selected immune and systemic inflammation parameters among obese patients with NIDDM.

PSORIASIS IN HIV-INFECTED PATIENTS: CLINICAL AND LABORATORY EVALUATION, APPROACHES TO THERAPY

Clinical and laboratory evaluation of the effectiveness of therapy of psoriasis vulgaris in 78 HIV-infected patients using the two treatment regimens is presented. Peculiarities of clinical course of psoriasis depending on the number of CD4+lymphocytes in the peripheral blood are shown. Histological and histochemical studies of biopsy samples from psoriatic skin lesions and apparently healthy skin in 15 people were performed. The dynamics before and after treatment of CD4+ and CD8+ lymphocytes in biopsies of skin and blood, their relationship with the index of severity of psoriasis (PASI) are presented. This study is of theoretical and practical interest in understanding the value and role of CD4+ and CD8+ lymphocytes in the formation of inflammatory reactions in the skin of patients with psoriasis as a possible option for treatment of psoriasis in HIV-infected patients.

Improved HIV-1 Viral Load Monitoring Capacity Using Pooled Testing With Marker-Assisted Deconvolution.

Improve pooled viral load (VL) testing to increase HIV treatment monitoring capacity, particularly relevant for resource-limited settings. We developed marker-assisted mini-pooling with algorithm (mMPA), a new VL pooling deconvolution strategy that uses information from low-cost, routinely collected clinical markers to determine an efficient order of sequential individual VL testing and dictates when the sequential testing can be stopped. We simulated the use of pooled testing to ascertain virological failure status on 918 participants from 3 studies conducted at the Academic Model Providing Access to Healthcare in Eldoret, Kenya, and estimated the number of assays needed when using mMPA and other pooling methods. We also evaluated the impact of practical factors, such as specific markers used, prevalence of virological failure, pool size, VL measurement error, and assay detection cutoffs on mMPA, other pooling methods, and single testing. Using CD4 count as a marker to assist deconvolution, mMPA significantly reduces the number of VL assays by 52% [confidence interval (CI): 48% to 57%], 40% (CI: 38% to 42%), and 19% (CI: 15% to 22%) compared with individual testing, simple mini-pooling, and mini-pooling with algorithm, respectively. mMPA has higher sensitivity and negative/positive predictive values than mini-pooling with algorithm, and comparable high specificity. Further improvement is achieved with additional clinical markers, such as age and time on therapy, with or without CD4 values. mMPA performance depends on prevalence of virological failure and pool size but is insensitive to VL measurement error and VL assay detection cutoffs. mMPA can substantially increase the capacity of VL monitoring.

Applicated value of CD4+ T lymphocyte count in the diagnosis of AIDS complicated with pulmonary tuberculosis

Objective To explore the value of CD4+ T lymphocyte count in laboratory diagnosis of AIDS complicated with pulmonary tuberculosis. Methods Forty-three patients with acute tuberculosis were selected as the subjects. Among them, 14 patients had typical tuberculosis(X-ray or chest CT), 29 cases were atypical tuberculosis(X-ray or chest CT). 43 patients were examined by CD4+ T lymphocyte count, sputum smear tuberculosis acid-fast bacilli test and T-SPOT.TB(interferon-γ release test), and the results of various methods were compared. Results The The number of CD4+ T lymphocytes in patients with typical pulmonary tuberculosis was (151.26±59.47)/μL, and that in atypical pulmonary tuberculosis was (69.11±19.65)/μL, the difference was statistically significant(t=5.124, P<0.05); and with the reduction of CD4+ T lymphocytes, AIDS patients showed more atypical pulmonary tuberculosis. The positive detection rates of CD4+ T lymphocyte count, T-SPOT.TB and sputum smear were 86.05%, 16.28% and 51.16% respectively. The positive rate of combined detection of three methods(90.70%) was significantly higher, the differences were statistically significant(χ2=5.123, 6.023, 7.125, all P<0.05). Conclusion CD4+ T lymphocyte count is of great value in the laboratory diagnosis of AIDS complicated with tuberculosis, and it is worthy to be widely carried out in clinical practice. Key words: T-lymphocytes; Acquired immunodeficiency syndrome; Tuberculosis, pulmonary

The variation of circulating regulatory T cells count of lung carcinoma and its prognostic value for evaluating treatment response

Objective To investigate the prognostic value of CD4+ CD25+ CD127low/- regulatory T cells (Treg) in peripheral blood samples, tumor markers for lung cancer (TM) and associated clinicopathologic features for evaluating pre-treatment predictors of non-small cell lung cancer (NSCLC). Methods The percentages of Treg were measured by flow cytometry, the level of serum TM was analyzed by enzyme linked immunosorbent assay (ELISA); and then Treg cells, serum TM level and associated clinicopathologic features were used to evaluate the predictive value of NSCLC treatment. Results The percentages of Treg cells in patients with NSCLC were significantly higher than those in healthy control [(7.02±2.31)% vs. (4.53±0.86)%, t=6.949, P=0.000]. In the areas of lung cancer, a significant positive correlation was found among the percentages of Treg cells and degree of differentiation (F=15.229, P=0.000), tumor size (t=-2.972, P=0.003), TNM stage (t=-4.856, P=0.001), vascular tumor thrombus (t=-0.653, P=0.000). The baseline circulating Treg count and the serum TM level before treatment in NSCLC were lower in the patient group with positive treatment response than in the group with negative response [Treg: (5.77±1.71)% vs. (7.02±2.02)%, t=-3.983, P=0.001; cytokeratin 19 fragment (CYFRA21-1): 2.88 (2.13-4.44) vs. 4.76 (2.82-8.95), t=4.032, P=0.000; carcinoembryonic antigen (CEA): 2.72 (1.54-4.01) vs. 3.53 (1.99-8.42), t=2.385, P=0.017; carbohydrate antigen (CA)125: 9.90 (6.50-14.70) vs. 19.20 (11.50-57.25), t=5.148, P=0.000]. Through logistic regression analysis, it revealed that pre-treatment Treg count and TNM stage were independent prognostic factors for clinical response to NSCLC treatment [odds ratio (OR)=3.993, P=0.001; OR=1.742, P=0.000]. Conclusion The percentage of Treg cells was closely related to the severity of NSCLC development, and pre-treatment Treg count and TNM stage were a feasible method to predict clinical response to NSCLC treatment. Key words: Lung carcinoma; Regulatory T cells; Tumor marker; Treatment response

Prognostic significance of tumor infiltrating immune cells in oral squamous cell carcinoma

BackgroundPrognostic factors aid in the stratification and treatment of cancer. This study evaluated prognostic importance of tumor infiltrating immune cell in patients with oral squamous cell carcinoma.MethodsProfiles of infiltrating immune cells and clinicopathological data were available for 78 OSCC patients with a median follow-up of 48 months. The infiltrating intensity of CD8, CD4, T-bet, CD68 and CD57 positive cells were assessed by immunohistochemistry. Chi-square test was used to compare immune markers expression and clinicopathological parameters. Univariate and multivariate COX proportional hazard models were used to assess the prognostic discriminator power of immune cells. The predictive potential of immune cells for survival of OSCC patients was determined using ROC and AUC.ResultsThe mean value of CD8, CD4, T-bet, CD68 and CD57 expression were 28.99, 62.06, 8.97, 21.25 and 15.75 cells per high-power field respectively. The patient cohort was separated into low and high expression groups by the mean value. Higher CD8 expression was associated with no regional lymph node metastasis (p = 0.033). Patients with more abundant stroma CD57+ cells showed no metastasis into regional lymph node (p = 0.005), and early clinical stage (p = 0.016). The univariate COX regression analyses showed that no lymph node involvement (p < 0.001), early clinical stage (TNM staging I/II vs III/IV, p = 0.007), higher CD8 and CD57 expression (p < 0.001) were all positively correlated with longer overall survival. Multivariate COX regression analysis showed that no lymph node involvement (p = 0.008), higher CD8 (p = 0.03) and CD57 (p < 0.001) expression could be independent prognostic indicators of better survival. None of CD4, T-bet or CD68 was associated with survival in ether univariate or multivariate analysis. ROC and AUC showed that the predictive accuracy of CD8 and CD57 were all superior compared with TNM staging. CD57 (AUC = 0.868; 95% CI, 0.785–0.950) and CD8 (AUC = 0.784; 95% CI, 0.680–0.889) both provided high predictive accuracy, of which, CD57 was the best predictor.ConclusionTumor stroma CD57 and CD8 expression was associated with lymphnode status and independently predicts survival of OSCC patients. Our results suggest an active immune microenvironment in OSCC that may be targetable by immune drugs.

Laboratory-based performance evaluation of PIMA CD4 + T-lymphocyte count point-of-care by lay-counselors in Kenya

BackgroundCD4+ T-lymphocyte count testing at the point-of-care (POC) may improve linkage to care of persons diagnosed with HIV-1 infection, but the accuracy of POC devices when operated by lay-counselors in the era of task-shifting is unknown. We examined the accuracy of Alere's Pima™ POC device on both capillary and venous blood when performed by lay-counselors and laboratory technicians. MethodsIn Phase I, we compared the perfomance of POC against FACSCalibur™ for 280 venous specimens by laboratory technicians. In Phase II we compared POC performance by lay-counselors versus laboratory technicians using 147 paired capillary and venous specimens, and compared these to FACSCalibur™. Statistical analyses included Bland-Altman analyses, concordance correlation coefficient, sensitivity, and specificity at treatment eligibility thresholds of 200, 350, and 500cells/μl. ResultsPhase I: POC sensitivity and specificity were 93.0% and 84.1% at 500cells/μl, respectively. Phase II: Good agreement was observed for venous POC results from both lay-counselors (concordance correlation coefficient (CCC)=0.873, bias −86.4cells/μl) and laboratory technicians (CCC=0.920, bias −65.7cells/μl). Capillary POC had good correlation: lay-counselors (CCC=0.902, bias −71.2cells/μl), laboratory technicians (CCC=0.918, bias −63.0cells/μl). Misclassification at the 500 cells/μl threshold for venous blood was 13.6% and 10.2% for lay-counselors and laboratory technicians and 12.2% for capillary blood in both groups. POC tended to under-classify the CD4 values with increasingly negative bias at higher CD4 values. ConclusionsPima™ results were comparable to FACSCalibur™ for both venous and capillary specimens when operated by lay-counselors. POC CD4 testing has the potential to improve linkage to HIV care without burdening laboratory technicians in resource-limited settings.

Estudio caso-control de tumores no definitorios de sida en una cohorte prospectiva de pacientes infectados por el VIH

IntroductionWe present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality. MethodsAll NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected. ResultsTwo hundred and twenty-one NADCs were diagnosed in an initial cohort of 7,067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1,000 people-year. In addition to aging and smoking, time on ART (OR 1.11; 95% CI 1.05-1.17) and PI use (OR 1.72; 95% CI 1.0-2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99-1.0; P=.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08-3.92) were associated with higher mortality. ConclusionsPredictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS.

Long-term pulmonary complications in perinatally HIV-infected youth

Increased incidence and prevalence of asthma have been documented for perinatally HIV-infected youth 10 to 21years of age compared with HIV-exposed uninfected (HEU) youth. We sought to perform objective pulmonary function tests (PFTs) in HIV-infected and HEU youth with and without diagnosed asthma. Asthma was determined in 370 participants (218 HIV-infected and 152 HEU participants) by means of chart review and self-report at 13 sites. Interpretable PFTs (188 HIV-infected and 132 HEU participants) were classified as obstructive, restrictive, or normal, and reversibility was determined after bronchodilator inhalation. Values for HIV-1 RNA, CD4 and CD8 T cells, eosinophils, total IgE, allergen-specific IgE, and urinary cotinine were measured.Adjusted prevalence ratios (PRs) of asthma and PFT outcomes weredetermined for HIV-infected participants relative toHEU participants, controlling for age, race/ethnicity, and sex. Current asthma was identified in 75 (34%) of 218 HIV-infected participants and 38 (25%) of 152 HEU participants (adjusted PR, 1.33; P=.11). The prevalence of obstructive disease did not differ by HIV status. Reversibility was less likely in HIV-infected youth than in HEU youth (17/183 [9%] vs 21/126 [17%]; adjusted PR, 0.47; P=.020) overall and among just those with obstructive PFT results (adjusted PR, 0.46; P=.016). Among HIV-infected youth with current asthma, serum IgE levels were inversely correlated with CD8 T-cell counts and positively correlated with eosinophil counts and not associated with CD4 T-cell counts. HIV-infected youth had lower association of specific IgE levels to several inhalant and food allergens compared with HEU participants and significantly lower CD4/CD8 T-cell ratios (suggesting immune imbalance). Compared with HEU youth, HIV-infected youth demonstrated decreased reversibility of obstructive lung disease, which is atypical of asthma. This might indicate an early stage of chronic obstructive pulmonary disease. Follow-up into adulthood is warranted to further define their pulmonary outcomes.

Correlations between tumor-infiltrating and circulating lymphocyte subpopulations in mRCC patients treated with immune-checkpoint inhibitors.

494 Background: In clinical trials with immune-checkpoint inhibitors (CKI), histological features such as tumor-infiltrating lymphocites (TILs) are investigated as potential predictive biomarkers, with the possible limit of an outdated parameter for a typically dynamic element. Methods: This explorative study compared, in metastatic renal cell carcinoma (mRCC) patients, basal pathological data about TILs on diagnostic histological specimens with circulating lymphocyte subpopulations measured before and during therapy with nivolumab, with the primary aim to assess their concordance. Secondarily, with the limit of a small sample size, a possible relation with treatment outcome was explored. Results: Of 11 mRCC patients, 5 had low presence of TILs (L-TILs), 3 moderate amount (M-TILs), and 3 high number (H-TILs). Overall, 8 patients had low intratumoral pathological CD4+/CD8+ ratio (LIPR) ≤ 1 and 3 cases high intratumoral pathological ratio (HIPR) ≥ 2. Of 8 patients with LIPR, only 2 cases matched with low circulating CD4+/CD8+ ratio (LCR) ≤1, whilst 5 cases had high circulating ratio (HCR) ≥ 2 (1 undetermined). All 3 cases with HIPR (≥ 2) conversely had LCR (≤ 1). Unexpectedly, independently from the clinical outcome, circulating CD4+/CD8+ ratio remained unchanged during therapy with CKI in each patient, maintaining the same value after 8 weeks (mean -0.12). The respective percentage values of CD4+ and CD8+ circulating T cells also remained stable during treatment (mean variation 0%); the absolute value of CD4+ was more likely to increase (mean +46.3/mm3); the level of CD8+ tended to slightly decrease (mean -6.5/mm3). No correlation of lymphocyte subpopulations with treatment outcome was found. Conclusions: Of note, this study did not evidence any correspondence between histopathological and circulating findings in terms of T-lymphocyte subpopulations in mRCC patients undergoing treatment with CKI, also suggesting the inconsistency of circulating data in terms of relative variations. Considering the likely high dynamism of TILs, rebiopsy before CKI therapy might be the most reliable way to assess the utility of TILs characterization for predictive purpose.

Trend of CD4+ Cell Counts at Diagnosis and Initiation of Highly Active Antiretroviral Therapy (HAART): Korea HIV/AIDS Cohort Study, 1992-2015.

BackgroundCD4+ cell counts reflect immunologic status of human immunodeficiency virus (HIV) patients. Recommended CD4+ cell counts for the initiation of highly active antiretroviral therapy (HAART) has increased over the past several years in various HIV treatment guidelines. We investigated the trend of CD4+ cell counts at diagnosis and treatment start using data from the Korea HIV/acquired immune deficiency syndrome (AIDS) Cohort Study.Materials and MethodsThe Korea HIV/AIDS Cohort Study started in 2006 and enrolled HIV patients from 21 tertiary and secondary hospitals in South Korea. The data for CD4+ cell counts at diagnosis and HAART initiation from these HIV patients were analyzed by three-year time intervals and presented by number of CD4+ cells (≤100, 101-200, 201-350, 351-500 and >500 cells/mm3). The HIV-RNA titer at diagnosis and HAART initiation were presented by 3-year intervals by groups ≤50,000, 50,001-100,000, 100,001-200,000, 200,001-1,000,000, and >1,000,000 copies/mL.ResultsMedian values of CD4+ cell count and HIV-RNA titer at initial HIV diagnosis were 247 cells/mm3 and 394,955 copies/mL, respectively. At time of initiating HAART, median values of CD4+ cell count and HIV-RNA were 181 cells/mm3 and 83,500 copies/mL, respectively. Patients with low CD4+ cell count (CD4+ cell count ≤200 cells/mm3) at diagnosis (31-51%) and initiation of HAART accounted for the largest proportion (30-65%) over the three-year time intervals. This proportion increased until 2010-2012.ConclusionCD4+ cell count at initiation of HAART was found to be very low, and the increase in late initiation of HAART in recent years is of concern. We think that this increase is primarily due to an increasing proportion of late presenters. We recommend early detection of HIV patients and earlier start of HAART in order to treat and prevent spread of HIV infection.

Demographic and clinical correlates of HIV-1 RNA levels in antiretroviral therapy-naive adults attending a tertiary hospital in Jos, Nigeria

BackgroundPlasma HIV-RNA viral load (VL) of HIV-infected persons is an important prognostic factor in HIV management. We determined the VL among antiretroviral therapy (ART)-naive patients to identify the association between patients’ demographic, clinical and laboratory characteristics with VL. MethodA cross-sectional study of 224 ART-naive HIV-1-infected patients (≥15 years of age) accessing care at the Jos University Teaching Hospital AIDS Prevention Initiative in Nigeria ART treatment centre, from October 2010 to April 2011. A log-linear model was used to determine if VL was related to demographic and clinical variables. ResultsThe patients had a median (interquartile range) age of 34 (28–41) years with females in the majority (59%). Females compared to males and pulmonary tuberculosis (PTB) co-infected compared to not co-infected patients had a significantly higher VL (14.9 loge versus 11.5 logeP=0.003 and 11.31 loge versus 11.89 logeP=0.047, respectively). VL tended to decrease with increasing CD4+ cell count levels in females, but remained relatively unchanged in males across all values of CD4+ cell counts. The difference (β) in the mean change in VL between males and females was loge 0.64 copies/mL, P=0.005. ConclusionIn ART-naive HIV-1-infected patients in our setting, females had significantly higher VL and lower CD4+ cell count, at the same VL threshold, compared to males, and hence were more likely to be at a higher risk of rapid progression to AIDS. Therefore, gender-based strategies for early identification and engaging females into care are required in this setting to mitigate against rapid progression to AIDS.

T-lymphocyte Subsets as a Prognostic Factor in a Clinical Course of Chickenpox.

Objective:To investigate possible prognostic values of CD4+, CD8+ T-lymphocytes, CD4/CD8 ratio to clinical course of chickenpox in immunocompetent hosts.Materials and methods:We performed a prospective study which included 69 immunocompetent patients with chickenpox who were addmited to Clinic for infectious disease, Clinical Center University of Sarajevo, in a 18 month period. All patients were divided into two groups depending on clinical presentation on admission. Patients with mild clinical form were dedicated to „outpatient” group, and patients with moderate, severe or life-threatening clinical forms were dedicated to „hospitalized” group. Also 30 healthy volunteers are included in study as a control group. We analyzed values of CD4+, CD8+ percentage, CD4/CD8 ratio with comparison to clinical course of chickenpox. All specimens were taken in acute phase of illness.Results:Values of CD4+ percentage were significantly declined in a group of hospitalized patients, compared to group of outpatients and control group. Values of CD8+ percentage were higher in a group of hospitalized patients, while CD4/CD8 values were lower in comparison to a group of outpatients and control group.Conclusion:We found significant correlation between these parameters and clinical course of chickenpox.

HIV viral load as an independent risk factor for tuberculosis in South Africa: collaborative analysis of cohort studies.

Introduction: Chronic immune activation due to ongoing HIV replication may lead to impaired immune responses against opportunistic infections such as tuberculosis (TB). We studied the role of HIV replication as a risk factor for incident TB after starting antiretroviral therapy (ART).Methods: We included all HIV-positive adult patients (≥16 years) in care between 2000 and 2014 at three ART programmes in South Africa. Patients with previous TB were excluded. Missing CD4 cell counts and HIV-RNA viral loads at ART start (baseline) and during follow-up were imputed. We used parametric survival models to assess TB incidence (pulmonary and extrapulmonary) by CD4 cell and HIV-RNA levels, and estimated the rate ratios for TB by including age, sex, baseline viral loads, CD4 cell counts, and WHO clinical stage in the model. We also used Poisson general additive regression models with time-updated CD4 and HIV-RNA values, adjusting for age and sex.Results: We included 44,260 patients with a median follow-up time of 2.7 years (interquartile range [IQR] 1.0–5.0); 3,819 incident TB cases were recorded (8.6%). At baseline, the median age was 34 years (IQR 28–41); 30,675 patients (69.3%) were female. The median CD4 cell count was 156 cells/µL (IQR 79–229) and the median HIV-RNA viral load 58,000 copies/mL (IQR 6,000–240,000). Overall TB incidence was 26.2/1,000 person-years (95% confidence interval [CI] 25.3–27.0). Compared to the lowest viral load category (0–999 copies/mL), the adjusted rate ratio for TB was 1.41 (95% CI 1.15–1.75, p < 0.001) in the highest group (>10,000 copies/mL). Time-updated analyses for CD4/HIV-RNA confirmed the association of viral load with the risk for TB.Conclusions: Our results indicate that ongoing HIV replication is an important risk factor for TB, regardless of CD4 cell counts, and underline the importance of early ART start and retention on ART.