Absolute Lymphocyte Count as a Surrogate Marker of CD4 Count in Monitoring HIV Infected Individuals: A Prospective Study

Agrawal, Preeti Balkisanji; Rane, Sharda R; Jadhav, Meenal Vitthal

doi:10.7860/jcdr/2016/19263.7765

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…A statistically reliable relationship was obtained between ALC and CD4 count. In the present study, when the ALC was <1,000 cells/mm 3 , the CD4 count was invariably <200 cells/mm 3 , and similarly, an ALC of >2,000 cells/mm 3 could predict a CD4 count of >200 cells/mm 3 which was in concordance with Agarwal et al, (16).…”

Section: Bone Marrow Findingssupporting

confidence: 92%

HIV Myelopathy- A cross-sectional study of constellation of bone marrow findings in HIV/AIDS

et al. 2021

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Introduction and Aim: Haematological manifestations in HIV disease is common and can happen at any phase during the disease course. Anemia and thrombocytopenia are the most frequent hematologic abnormalities and are associated with high morbidity and mortality. The objective of current study was to observe and analyse various spectrum of bone marrow changes and haematological abnormalities in HIV/AIDS and to correlate findings with CD4 count. Material and Methods: A total of 44 patients over a period of 5 years were included. Clinical findings, hematological profile, bone-marrow aspirate, biopsy findings and CD4 count of these patients were documented. The association between absolute lymphocyte count (ALC) and CD4 count were further established. Results: The most common clinical indication for bone-marrow aspiration and trephine biopsy was pancytopenia (47.3%), pyrexia of unknown origin (15.1%), and unresolving hepatosplenomegaly (13.6%). Anemia (72.7%) was commonest haematological abnormality. Bone marrow aspirate was normocellular in majority of patients. Marrow findings were correlated with CD4 count and were found to be statistically significant. Tri-lineage dysplasia was observed in 9.1% of patients, and megakaryocytic dysplasia being the commonest(61.4%). Histiocytic aggregates (27.3%) were noted among which 6.8% showed acid fast bacilli in Ziehl-Neelsen stain. Fungal stains revealed histoplasmosis in 4.5% patients. Conclusion: There was a strong negative association between presence of anemia and dysplasia and CD4 count. When CD4 was <200/µL and ALC<1000/mm3, presence of anemia and dysplasia affecting various cell lines were commonly observed; therefore, can be used as indicators to assess the severity of the disease.

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Section: Bone Marrow Findingssupporting

confidence: 92%

HIV Myelopathy- A cross-sectional study of constellation of bone marrow findings in HIV/AIDS

et al. 2021

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“…Another study ( Mansharamani et al, 2000 ) indicated that in immunosuppressed persons without HIV infection, CD4 + counts may be a useful clinical marker to identify specific individuals at particularly high clinical risk for PJP. Previous prospective study ( Agrawal et al, 2016 ) showed that Absolute Lymphocyte Count <1643 μl but not 1200 μl could be the cost-effective surrogate marker for CD4 cell counts <200 cells/μL in monitoring HIV infected individuals. Moreover, a recent meeting abstract ( Joshi et al, 2019 ) in 2019 ASCO Annual Meeting indicated that low ALC (750/μL, median) and prolonged steroid therapy are more likely to result in PJP infection as opposed to steroid therapy alone.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jirovecii pneumonia associated with immune checkpoint inhibitors: A systematic literature review of published case reports and disproportionality analysis based on the FAERS database

et al. 2023

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Background: Pneumocystis jirovecii pneumonia (PJP) has been reported with ICIs but limited to case reports. The clinical features of PJP with ICIs remain mostly unknown. This study aims to investigate the association of PJP with ICIs and describe clinical features.Methods: Reports of PJP recorded in FAERS (January 2004–December 2022) were identified through the preferred term “Pneumocystis jirovecii pneumonia”. Demographic and clinical features were described, and disproportionality signals were assessed through the Reporting Odds Ratio (ROR) and Information Component (IC), using traditional chemotherapy and targeted therapy as comparators, and adjusting signals by excluding contaminant immunosuppressive drugs and pre-existing diseases. A systematic literature review was conducted to describe clinical features of published PJP reports with ICIs. Bradford Hill criteria was adopted for global assessment of the evidence.Results: We identified 677 reports of PJP associated with ICIs, in which 300 (44.3%) PJP cases with fatal outcome. Nivolumab (IC025 2.05), pembrolizumab (IC025 1.88), ipilimumab (IC025 1.43), atezolizumab (IC025 0.36), durvalumab (IC025 1.65), nivolumab plus ipilimumab (IC025 1.59) have significant signals compared to other drugs in FAERS database. After excluding pre-existing diseases and immunosuppressive agents which may increase susceptibility of PJP, the signals for PJP associated with nivolumab, pembrolizumab, durvalumab, nivolumab plus ipilimumab remained robust (IC025 > 0). When compared to other anticancer regimens, although all ICIs showed a lower disproportionate signal for PJP than chemotherapy, nivolumab (IC025 0.33, p < 0.001), pembrolizumab (IC025 0.16, p < 0.001), both PD-1 inhibitors, presented a higher signal for PJP than targeted therapy. Male gender (IC025 0.26, p < 0.001) and age >65 years (IC025 0.38, p < 0.001) were predominant in PJP cases associated with across all ICIs. In literature, 15 PJP cases associated with ICIs were reported in 10 published case reports. 12 of 15 (80.0%) of cases received PD-1 inhibitors before PJP was diagnosed.Conclusion: By the combined analysis of post-marketing data from FAERS and published case reports, we identified ICIs may be associated with PJP, especially in males aged >65years. After accounting for confounders, PD-1 inhibitors emerged with a robust disproportionality signal when compared to PD-L1/CTLA-4 inhibitors as well as targeted therapy. Further research is warranted to validate our findings.

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“…Our study supports the finding of a previous study, which discovered a strong correlation coefficient between CD4+ in peripheral blood and total lymphocytes in COVID-19 patients (r = 0.9051, p < 0.01) ( Sun et al, 2020 ). Meanwhile, prior research on Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) patients identified a significant relationship between ALC and CD4 cell count with an r-value of 0.327 ( p < 0.05) ( Agrawal, Rane & Jadhav, 2016 ). Nevertheless, in the multiple sclerosis patients, both CD4+ and CD8+ T-cells correlated significantly with ALC from treatment initiation to week 96 of observation (r = 0.559−0.880; p < 0.001) ( Longbrake et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

CD4+ and CD8+ cell counts are significantly correlated with absolute lymphocyte count in hospitalized COVID-19 patients: a retrospective study

Liana,

Samosir,

Sari

et al. 2023

PeerJ

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Background Coronavirus disease 2019 (COVID-19) is a contagious respiratory illness that was declared a pandemic in March 2020. Lymphopenia is one of the specific laboratory results disturbance in COVID-19 patients. Such findings are frequently associated with substantial changes in T-cell counts, particularly CD4+ and CD8+ T-cells. This study aimed to examine the correlation between CD4+ and CD8+ cell counts and absolute lymphocyte count (ALC) in COVID-19 patients and analyze its difference based on the COVID-19 patients’ severity. Methods From March 2022 to May 2022, we conducted a retrospective cohort study using medical records and laboratory data from patients diagnosed with COVID-19 at our hospital who met the inclusion and exclusion criteria. The total sampling method was used to recruit study participants. We conducted bivariate analysis, which consisted of correlation and comparative analysis. Results Thirty-five patients met the inclusion and exclusion criteria and were divided into two severity groups (mild-moderate and severe-critical). The findings of this study revealed a significant correlation between CD4+ cell count and ALC on admission (r = 0.69, p < 0.001) and the tenth day of onset (r = 0.559, p < 0.001). Similarly, there was a correlation between CD8+ and ALC at admission (r = 0.543, p = 0.001) and on the tenth day of onset (r = 0.532, p = 0.001). Individuals with severe-critical illness had lower ALC, CD4+, and CD8+ cell counts than those with mild-moderate illness. Conclusion According to the findings of this study, there is a correlation between CD4+ and CD8+ cell counts and ALC in COVID-19 patients. All lymphocyte subsets also showed a lower value in severe forms of the disease.

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Absolute Lymphocyte Count as a Surrogate Marker of CD4 Count in Monitoring HIV Infected Individuals: A Prospective Study

Cited by 5 publications

References 11 publications

HIV Myelopathy- A cross-sectional study of constellation of bone marrow findings in HIV/AIDS

HIV Myelopathy- A cross-sectional study of constellation of bone marrow findings in HIV/AIDS

Pneumocystis jirovecii pneumonia associated with immune checkpoint inhibitors: A systematic literature review of published case reports and disproportionality analysis based on the FAERS database

CD4+ and CD8+ cell counts are significantly correlated with absolute lymphocyte count in hospitalized COVID-19 patients: a retrospective study

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