British Microbiology Research Journal 9(6): 1-7, 2015, Article no.BMRJ.19294 ISSN: 2231-0886
SCIENCEDOMAIN international www.sciencedomain.org
A Review of CD4 Positive T Lymphocytes Counts among HIV Positive Patients Attending a Nigerian Teaching Hospital S. I. Nwadioha1*, M. S. Odimayo1, G. T. A. Jombo1, E. O. Nwokedi Prince1 and M. Atef1 1
Department of Medical Microbiology, Benue State University Teaching Hospital, Makurdi, Nigeria. Authors’ contributions
This work was carried out in collaboration between all authors. All authors read and approved the final manuscript. Article Information DOI: 10.9734/BMRJ/2015/19294 Editor(s): (1) Preeti Bharaj, Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, USA. Reviewers: (1) Nélida Virginia Gómez, Buenos Aires University, Argentina. (2) Anonymous, Achievers University, Owo, Nigeria. Complete Peer review History: http://sciencedomain.org/review-history/10287
st
Original Research Article
Received 1 June 2015 Accepted 14th July 2015 rd Published 23 July 2015
ABSTRACT Aims and Objectives: To determine the baseline CD4 positive T lymphocytes count of HIV/AIDS treatment naïve adults clients presenting for the first time treatment in Benue State University Teaching Hospital. Subjects and Methods: A total of 700 subjects age between 18 years to 70 years, were recruited for the study, comprising 600 HIV sero-positive patients and 100 healthy controls in Benue State University Teaching Hospital, Makurdi from 2013 to 2014. The CD4 counts of the subjects were evaluated using a Partec flow cytometer. Results: CD4 count of 200-299 cells/μl peaked with 25% (n=150/600) [control; 0% (n= 0/100)]. The study also showed that 44% (266/600) of HIV subjects had acquired immunodeficiency syndrome as defined by low CD4 counts below 200 cells/μl. Seventy-five per cent (n=451/600) of our patients would require to be placed on antiretroviral therapy with CD4 count below 350 cells/μl. At CD4 350 baseline criterion, age group 20-29 years had the highest demand 35% (160/451) for ARV followed by age groups 30-39 and 40-49 years with 28% (128/451) and 22% (98/451) respectively. Conclusion: There is a high prevalence of acquired immunodeficiency syndrome among the young _____________________________________________________________________________________________________ *Corresponding author: E-mail:
[email protected];
Nwadioha et al.; BMRJ, 9(6): 1-7, 2015; Article no.BMRJ.19294
active productive age group as defined by CD4 counts below 200 cells/μl. The strict adopting of the ART WHO 2010 scale- up criteria doubles the number of the HIV clients that would qualify for ART with its attendant health benefits on the long run.
Keywords: CD4 counts; HIV patients; Nigeria.
1. INTRODUCTION
2. SUBJECTS AND METHODS
Cluster of differentiation is a protocol used for identification of cell surface molecules used as target of immunophenotyping of cells. Cluster of differentiation 4 (CD4) is a glycoprotein located on the surface of T-helper cells, macrophages, monocytes and dendritic immune cells [1]. The CD4 gene is responsible for synthesis of CD4 protein in humans [1]. CD4+ T helper lymphocytes play a pivotal role in control of immune response [2]. They generate antibodies through B cells, which further recruit and activate macrophages, eosinophils, neutrophils and basophils to the locations of infection and inflammation [2]. CD4+ T cells are the fundamental target cells for human immunodeficiency virus (HIV) and its count is applied in the decision of introducing antiretroviral therapy (ART) and in monitoring the efficacy of ART [2,3].
2.1 Study Population The study was conducted over a period of one year from January, 2013 to January, 2014 in Benue State University Teaching Hospital, Makurdi Nigeria. Approval by the Ethics and Research Committee of the Hospital and written or oral consent of the patients were sought before sample collection. The nature of the study was explained to the subjects in the simplest language they best understood. The study involved subjects from 18 years to 70 years who were willing to give their consent, same applied to both test and control. Subjects who did not give their consent were not considered. Questionnaires were given to those who gave their consent. Socio-demographic variables such as age, gender, occupation, ethnicity and CD4 count on initial hospital visit were recorded. A total of 700 adult subjects were recruited in the study, comprising 600 HIV sero-positives and 100 healthy controls from HIV clinics and general out patients clinics respectively. The controls were age and sex matched with the test group. Acquired immunodeficiency syndrome (AIDS) was defined by low CD4 counts below 200 cells/μl in HIV sero-positive patients.
CD4 cell count is said to be the most reliable prognostic indicator of immune response to therapy and is thus a major criterion in the CDC/WHO classification of HIV infection, which is widely used to categorize patients for clinical management [1,3]. Nigeria has an estimated 3.6% [3] national adult prevalence of HIV and 3 milion people living with HIV, representing second largest burden of disease on the continent [4] with Benue state having the highest HIV/AIDS (12.7%) endemicity [5] in the country.
2.2 HIV Serology The HIV sero-status and confirmation of results was determined by rapid testing of serum samples of patients according to in-country and WHO HIV serial testing algorithm where three rapid tests; Determine HIV 1-1/2 (ABBOT Laboratories, illnois USA) with sensitivity of 100% and specificity of 99.6%, SD Bioline HIV 1/2 3.0 (Standard Diagnostics, Korea) with sensitivity of 100% and specificity of 99.8% and UniGold (Trinity Biotech, Ireland) with sensitivity of 100% and specificity of 99.9% were used. Laboratory diagnosis of HIV infection was established by double rapid technique (Determine and Unigold) by serial testing strategy and any tie in the result was settled by using SD Bioline/Statpack as a tie-breaker. CD4 count was determined by Cyflow machine automation (Partec co-operation Germany).
The introduction of highly subsidized antiretroviral therapy in the country with its attendant influx of patients for treatment has necessitated this study of the baseline CD4 counts of HIVpositive patients on initial presentation to the HIV clinic of the Benue State University Teaching Hospital, Makurdi. High endemicity of HIV infection [5], underscores the need for the development of effective management modality for HIV in Benue State, Nigeria which will focus on sound diagnosis established through the determination of Epidemiology of the diagnostic parameters of the disease in this environment culminating in development of effective treatment options for HIV patients and significant reduction in incidence of HIV/AIDS in our locality. 2
Nwadioha et al.; BMRJ, 9(6): 1-7, 2015; Article no.BMRJ.19294
with 24% and CD4 count of 100-199 cells/μl in 20% of patients.
2.3 CD4 Count Aseptic procedures were adopted in the collection of the blood samples. Five millimeters of venous blood was obtained using sterile needle and syringe and dispensed into EDTA bottles. Samples were stored at 4°C until analyzed.
Forty - four per cent (266/600) of our HIV patients had acquired immunodeficiency syndrome (AIDS) as defined by low CD4 counts below 200 cells/μl. Seventy-five per cent (n=451/600) of our patients had CD4 count below 350 cells/μl (global ART scaling up criteria by WHO 2010). Age group 2029 years was highest by 35% (160/451) followed by age groups 30-39 and 40-49 years with 28% (n=128/451) and 22% (n=98/451) respectively while the least were age groups > 60 years and
