Determinants of CD4 Counts Among HIV-Negative Ethiopians: Role of Body Mass Index, Gender, Cigarette Smoking, Khat (Catha Edulis) Chewing, and Possibly Altitude?

Abstract

To study the determinants of CD4% and CD4 counts among HIVnegative Ethiopians, and to identify factors susceptible to explain the low CD4 counts observed among Ethiopian subjects. Cohort studies among factory workers in Akaki and Wonji, Ethiopia. Clinical and laboratory examinations, including determination of HIV serological status and T-cell subsets, were performed during follow-up visits every six months. In addition, micronutrients (retinol, carotenoids, tocopherol, transferrin receptor, and selenium) plasma concentrations were determined in a subset of 38 HIV-positive and 121 HIV-negative participants. HIV-negative participants with at least one CD4 count measurement were 157 females in Akaki, 203 males in Akaki, and 712 males in Wonji. CD4 counts were independently and positively associated with body mass index (through an increase in lymphocyte counts), female gender (through an increase in CD4%), cigarette smoking (through an increase in CD4%), khat chewing (through an increase in both lymphocyte counts and CD4%), and Akaki study site (through a large increase in lymphocyte counts compensating a decrease in CD4%). Intestinal parasitic infections were not associated with CD4% or CD4 counts. Retinol, carotenoids, and α-tocopherol plasma concentrations decreased with HIV infection and advancing immunosuppression, but were not associated with CD4 counts among HIV-negative subjects. Low body mass index among Ethiopians may have contributed to their overall low CD4 counts. Other factors remain to be elucidated.

Correlates of CD4+ and CD8+ Lymphocyte Counts in High-Risk Immunodeficiency Virus (HIV)-Seronegative Women enrolled in the Women’s Interagency HIV Study (WIHS)

“…Univariate and multivariate analyses further indicated that there is a dose-response effect of smoking, with greater number of cigarettes smoked per day associated with an increasing number of both CD4ϩ and CD8ϩ lymphocytes in the peripheral blood of HIV-negative women. Our finding of a positive association between CD4 cell count, smoking, and BMI are consistent with results of a similar study among HIVnegative Ethiopians [7]. However, correlates of CD8 cell counts were not reported in that study.…”

“…A total of 22 HIV negative women were excluded, because CD4 and CD8 cell counts were unavailable in these participants. Subjects in the original cohort contributed a median (range) of 11 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) visits and those in the new cohort contributed 3 (1-4) visits to the analysis. Baseline characteristics of the study participants are listed in Table 1.…”

Selenium biochemistry and its role for human health

“…214 Nevertheless, other studies have not found relatively low serum Se in HIV-1-infected subjects, suggesting that its deficiency in HIV-1 infection may be most likely to occur in subjects with poor diets, such as intravenous drug abusers and those living in poverty. 215,216 Thus, maintaining an optimal Se status in HIV-1 patients may help to increase the enzymatic defence, improve general health and reduce their risk of hospitalization for opportunistic infections and complications. 217 …”

Profound reduction of CD4+ lymphocytes without HIV infection: two cases from the horn of Africa

“…Our patient was severely malnourished and this is also a cause of immunodeficiency. A significant reduction of the CD4 lymphocytes can occur in conditions with no HIV infection 16 , including severe wasting, as described in Ethiopia 17 .…”