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

Abstract

Background and objectives: Human immunodeficiency virus (HIV) infection is a global healthcare problem. Low CD4 cells count, an index of immunosuppression, is associated with escalating activity and progression of HIV infection. The factors which influence low CD4 cells count have not been completely identified nor are they evaluated in routine clinical practice. The aim of this study was to determine the prevalence of low CD4 cells count and to evaluate the factors which might influence immunosuppression in treatment-naïve HIV subjects in Southeast Nigeria.Methodology: This was a cross-sectional study involving treatment-naïve HIV subjects. Anthropometric and demographic data were obtained and CD4 cells count and other relevant investigations performed. The data were compared between those who have low CD4 cells count, defined, here, as CD4 <200 cells/ml, and those with CD4 ≥ 200 cells/ml. Potential risk factors of low CD4 cells count were determined. Results:The mean age of the subjects was 39+11 years. Females were made up 283 (72.0%) and males 110 (28.0%). The median value of the CD4 cells count was 391. Low CD4 cells count was prevalent in 49 (12.5%) of the subjects. There was significant association between CD4 cells count and body mass index (df=2, p=0.017), as well as serum low density lipoprotein cholesterol (df=1, p=0.027) and anemia (df=3, p=0.025). Significant, but poor, correlation was observed between CD4 cells count and 24 h urine protein (r=-0.117, p=0.023), creatinine clearance (r=-0.122, p=0.018), as well as hemoglobin (r=0.224, p<0.001). Creatinine clearance was a predictor of low CD4 cells count, p=0.001. Conclusion:The prevalence of low CD4 cells count was high in this study. Abnormal weight, dyslipidemia and proteinuric renal damage were common among treatment-naïve subjects who have low CD4 cells count. referrals from the neighboring states. Owerri, where the hospital situates, has a local municipal population of about 125,337, whereas the state population is conservatively put at 3,927,563 [18].The criteria for inclusion in this study were age range of 16-65 years and treatment-naïve HIV-positive status. Pregnancy, adrenal disease, renal or terminal illness and malignancy were the exclusion criteria. From each of the study subjects, informed written consent was obtained. The Ethics Committee of the hospital gave approval for the study.From each of the subjects anthropometric and demographic data were obtained with the aid of a questionnaire administered by our laboratory technicians who explained to them the aim of the study. The place of domicile and origin, gender and age of the subjects were obtained. Weight and height were taken and BMI rendered as weight/ height 2 (kg/m 2 ). Blood pressure was measured [19].Clear instructions were given to all the subjects on how to collect 24 h urine sample. For each subject, a day-time random spot urine sample and blood samples were collected at the end of the 24 h urine sample collection [19][20][21].From the random spot urine samples coll...

Variable Influencing Parameters of Different Levels of Immunosuppression in HAART-naive HIV Subjects in Nigeria

“…Clear instructions were given to all the subjects on how to collect 24 h urine sample. For each participant, day-time blood samples and spot urine samples were collected at the end of the 24 h urine sample collection [8,[14][15][16].…”

“…Creatinine was determined by modified Jeff's method and protein by photometric method. Creatinine clearance (ClCr) was determined [8,[14][15][16].…”

“…Studies have shown some factors which might influence immunosuppression in HIV subjects and non-HIV individuals. [8][9][10][11]. These factors include body mass index (BMI), demography, genetics, behavior and sex workers, among others [8][9][10][11].…”

“…These factors include body mass index (BMI), demography, genetics, behavior and sex workers, among others [8][9][10][11]. A study has also demonstrated an association between low CD4 (<200 cells/ml) and BMI, serum low density lipoprotein cholesterol, anemia, 24 h urine protein, as well as creatinine clearance in treatment-naïve HIV subjects [8]. The advent of opportunistic infections and opportunistic malignancies are associated with immunosuppression in HIV infection [2,3,[6][7][8]12].…”

“…A study has also demonstrated an association between low CD4 (<200 cells/ml) and BMI, serum low density lipoprotein cholesterol, anemia, 24 h urine protein, as well as creatinine clearance in treatment-naïve HIV subjects [8]. The advent of opportunistic infections and opportunistic malignancies are associated with immunosuppression in HIV infection [2,3,[6][7][8]12]. There was a paucity of studies that assessed different levels of immunosuppression in HIV infected individuals.…”