Difference in Absolute CD4+ Count According to CD4 Percentage between Asian and Caucasian HIV-Infected Patients

Abstract

We compared the absolute CD4+ count, at different CD4+ percentages (CD4%), between Asian (n=442) and Caucasian (n=674) untreated HIV-infected individuals, using linear regression methods. At any given CD4%, Asians had lower CD4+ count than Caucasians (p=0.001). The difference varied from 38.9 cells/mm3 (95% CI: 3.3-74.5 cells/mm3) at CD4% of 15% to 108.7 cells/mm3 (95% CI: 42.5-174.9 cells/mm3) at CD4% of 40%. The impact of these differences on prognosis is uncertain, but it may be that the prognostic thresholds for CD4+ count used in Caucasian populations are inappropriate in Asian populations.

Joint estimation of CD4+ cell progression and survival in untreated individuals with HIV-1 infection

“…Cohorts from SE/E Asia experience faster CD4 + cell decline and higher mortality rates, and this, in combination with lower CD4 + cell counts at the time of seroconversion, leads to significantly shorter survival times compared with the other regions. A study across 17 clinical sites in Asia showed the total lymphocyte count and CD4 + cell count in untreated HIV-infected persons to be lower compared with a clinical study conducted in France [34]. The authors cite several potential explanations for the finding including variations in immune function or genetic factors.…”

10.4172/jaa.1000036

“…Maintenance of this native trimeric structure appears necessary to elicit the production of neutralizing antibodies. Conversely, the native structure of the HIV envelope shields it from many potentially neutralizing epitopes, such as the coreceptor binding site, which is made accessible only after CD4+ T cell binding [35]. Similarly, mutational substitution studies of glycosylation sites demonstrated that changes at these sites affected neutralization of distant epitopes [36].…”

A Brief Review on Immune Mediated Diseases

“…Total lymphocyte and CD4+ count is negatively affected by the poor nutritional status, and the prevalence of under-nutrition is generally higher in Asians [79,80]. Second, environmental factors including higher prevalence of background infections, such as Tuberculosis in Asian countries, may account for some of these differences [78,81]. World health organization (WHO) guidelines in 2010 [82] state that the total lymphocyte count (TLC) is no longer recommended to guide treatment decisions in adults and adolescents with human immunodeficiency virus (HIV).…”

“…The CD4+ T-cell lymphocyte count (henceforth CD4+ count) is one of the most important prognostic factors for progression of HIV infection and forms the basis for International recommendations for antiretroviral treatment and prophylaxis [75]. However, comparative studies between African and European populations suggest that total lymphocyte count (TLC), including CD4+ count, is likely to vary significantly by ethnicity, in both, healthy [76] and HIV-infected individuals [77,78]. Total lymphocyte and CD4+ count is negatively affected by the poor nutritional status, and the prevalence of under-nutrition is generally higher in Asians [79,80].…”