Factors associated with CD4 lymphocyte counts in HIV-negative Senegalese individuals

Abstract

Summary CD4+ lymphocytes are a primary target of the human immunodeficiency virus (HIV), and CD4 counts are one of the factors used to measure disease progression in HIV-positive individuals. CD4 counts vary in uninfected individuals and across populations due to a variety of demographic, environmental, immunological and genetic factors that probably persist throughout the course of HIV infection. This study sought to determine reference levels and identify factors that influence lymphocyte counts in 681 HIV-uninfected adults in Senegal, where residents are exposed to a variety of infectious diseases and other conditions that may affect CD4 counts. Lymphocyte counts were assessed in commercial sex workers, symptomatic men and women presenting to the University of Dakar infectious disease clinic for out-patient care and women seeking family planning services. CD4 and CD3 lymphocyte counts differed between the four study groups (P < 0·01). Men had the lowest mean CD4 count (711·6 cells/ml), while commercial sex workers had the highest levels (966·0 cells/ml). After adjustment for age and other behavioural and clinical factors, the difference in CD4 counts between the three groups of women did not remain. However, both gender and smoking were associated independently with CD4 counts, as men maintained lower mean CD4 counts (b = -156·4 cells/ml, P < 0·01) and smokers had higher mean CD4 counts (b = 124·0 cells/ml, P < 0·01) than non-smokers in multivariable analyses. This study is the first to explore factors that may influence CD4 levels in Senegal and to estimate baseline CD4 levels among HIV-negatives, information that may guide clinicians in interpreting CD4 counts.

Factors of Low CD4 Cells Count in Treatment-naïve HIV Subjects in Southeast Nigeria

“…The median CD4 cells count value of 391 found in this study is slightly higher than the 241 reported in a study in India [30] despite the background racial differences, but very much lower than the values found in normal healthy states [17]. This, together with the high prevalence of low CD4 cells count (CD4<200 cells/ml) of 12.5% tend to suggest that our study subjects have immunosuppression at onset.…”

“…These include demographic and genetic factors, low body mass index (BMI), commercial sex workers, and behavioral factors, all in HIV-negative individuals [8,[14][15][16][17]. In HIV-infected individuals, it has been demonstrated that low CD4 cells count is a predictor of AIDS syndrome and disease progression.…”

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

“…Several explanations could possibly account for these observed differences in CD4+ count. [18] Firstly, total lymphocyte and CD4+ count is negatively affected by the poor nutritional status,[19-20] and the prevalence of under-nutrition is generally higher in Asians. [21] Second, environmental factors including higher prevalence of background infections, such as Tuberculosis in Asian countries,[22] may account for some of these differences.…”

On the assessment of various factors effecting the improvement in CD4 count of aids patients undergoing antiretroviral therapy using generalized Poisson regression

“…Older patients and those with a low hemoglobin level or low body mass index (BMI) were at increased risk of mortality throughout follow-up and men gained fewer CD4 cells after treatment initiation than did women. Mair et al [16] inferred that both gender and smoking were associated independently with CD4 counts, as men maintained lower mean CD4 counts and non-smokers had higher mean CD4 counts than smokers in multivariable analyses. Giordano et al [9] studied patients on ART for a period of six months and used analysis of variance and covariance techniques to study the change in the CD4 count (difference between six months and the baseline count) and contribution of continuous data adjusted for categorical and continuous covariates.…”