scholarly journals Modeling of the change in CD4 lymphocyte counts in patients before and after administration of the human immunodeficiency virus protease inhibitor indinavir.

1997 ◽  
Vol 41 (2) ◽  
pp. 449-453 ◽  
Author(s):  
D S Stein ◽  
G L Drusano
Keyword(s):  
Cell Count ◽  
Rate Constants ◽  
Half Life ◽  
Cd4 Cells ◽  
Cd4 Cell Count ◽  
Immunodeficiency Virus ◽  
The Mean ◽  
Cd4 Lymphocyte ◽  
Cd4 Cell ◽  
Cd4 Lymphocytes

We investigated the relationships between changes in CD4 lymphocytes counts over 24 weeks after the initiation of therapy with indinavir at dosages of > or = 2.4 g/day (n = 15) in human immunodeficiency virus-positive patients and compared them to the baseline values. Starting CD4 count were linked to the time-weighted average CD4 cell count (return) through a nonlinear effect model. The diminution of destruction of CD4 cells after the initiation of indinavir therapy was estimated by fitting simultaneous differential equations to the data by using a linked lymph node (LN)-blood (BL) (two-compartment) system in which there is a constant rate of generation (R), first-order transfer rate constants (KLN-BL and KBL-LN) of compartment exchange, and first-order rate constants of CD4 destruction in the absence and presence of indinavir (KLN-OUT1 and KLN-OUT2). The half-life of CD4 lymphocytes was calculated from the rate constants by standard two-compartment methods. The CD4 lymphocyte counts at the start and return were linked in a sigmoid-Emax model were the maximal effect (Emax) was at 574.6 cells/microliters and 50% of the effect occurred at 157.1 cells/microliters (r2 = 0.94; P < 0.001). The mean +/- standard deviation (median) KLN-OUT2 was 0.574 +/- 0.202 (0.589), indicating that indinavir decrease the destruction of CD4 cells by circa 41 to 42%. The mean (median) CD4 half-life was 11.5 +/- 5.72 day (10.3 days). In multivariate analysis, KLN-OUT2 was significantly correlated with starting the CD4 cells count and the change in the CD4 cell count on therapy. The relationship between CD4 lymphocyte half-life and the starting CD4 lymphocyte count was hyperbolic, with a rapid increase in half-life as the CD4 count decreased. On the basis of the calculated half-life, the average production (destruction) of CD4 lymphocytes was approximately 3 x 10(9) cells/day, with an individual variation of 44-fold. These findings suggest that (i) the CD4 lymphocyte cell count at the start is significantly correlated to both the decrease in the destruction rate of CD4 cells and the degree of change in the CD4 lymphocytes on therapy, (ii) the lower the initial CD4 lymphocyte count, the higher the amount of CD4 lymphocyte turnover and the lower the ability of the immune system to increase absolute CD4 lymphocyte levels after viral suppression, consistent with a decreased regenerative capacity with progression of disease; and (iii) the increase in CD4 lymphocytes is likely secondary to the expansion of proliferating pool of cells since our determinations are based on 24 weeks of effect.

scholarly journals IS IT SAFE AND COST SAVING TO DEFER THE CD4+ CELL COUNT MONITORING IN STABLE PATIENTS ON ART WITH MORE THAN 350 OR 500 CELLS/µL?

2019 ◽  
Vol 11 (1) ◽  
pp. e2019063
Author(s):  
Benedetto Maurizio Celesia ◽  
Andrea Marino ◽  
Rosa Fontana del Vecchio ◽  
Roberto Bruno ◽  
Filippo Palermo ◽  
...  
Keyword(s):  
Cell Count ◽  
Mean Value ◽  
Cd4 Count ◽  
Cd4 Cells ◽  
Cd4 Cell Count ◽  
The Third ◽  
Cd4 Lymphocyte ◽  
Mean Cost ◽  
Cd4 Cell

Background CD4 lymphocyte cell count represents the main immunological marker used to monitor HIV infection. However, frequent monitoring may be unnecessary, could cause anxiety to the patient as well as burdening healthcare with extra expenses.   Objectives and methods To analyse the probability of maintaining a safe number of CD4 in HIV-positive subjects under treatment with ≥350 cells/µl at baseline during a three-year follow up. We conducted a retrospective study performing three analyses with Kaplan-Meyer method considering: 1) all patients independently from their viral load (VL); 2) patients with 500 > CD4 ≥ 350 cells/µl versus (vs) CD4 ≥ 500 cells/µl at baseline; 3) patients with VL < 20 copies/ml vs VL > 20 copies/ml.   Results 253 subjects were enrolled. The median CD4 count was 623 (489-805) cells/µl. Subjects maintaining ≥ 350 cells/µl in the first, second and third year were respectively 238 (94.1%), 229 (90.5%) and 226 (89.3%), independently from VL. Within subjects with ≥ 350 CD4/µl vs ≥ 500 CD4/µl at baseline, those who maintained ≥ 350 cells/µl until the third year were respectively 241 (95.3%) and 158 (98.1%). The probability of maintaining these values in the third year was 89.3% for those who had CD4 ≥ 350/µl at baseline and 98.1% for those who had CD4 ≥ 500/µl. This probability was around 90% vs 99% for subjects with HIV-RNA above or below 20 copies/ml. Secondly, we tried to estimate the costs of CD4 determinations in a three-year period (from April 1, 2013 to March 31, 2016). We analysed respectively 343 subjects in the first period, 364 in the second and 383 in the third, with a median value of 500 CD4/µl during the research time taken into account. We found a mean value of about two determinations patient/year (2.41 in 2013/2014; 2.32 in 2014/2015; 2.18 in 2015/2016), with a significant decrease between the first and the last period (p<0.001). The mean cost patient/year was €101.51 in the first year, €97.61 in the second, €92.00 in the third (p<0,001). Assuming to extend these procedures to all our patients with stable CD4 cells/µl and monitoring CD4 cell count once in a year, it could be possible to obtain an overall saving of €19,152/year.   Conclusions A very high percentage of subjects maintained a high and safe number of CD4 cells (>350 cells/µl) during a three-year follow up. It could be possible to save up to 66% of the costs by reducing the number of CD4 count determinations in a year, to have other favourable consequences as well, releasing new resources for patient’s management.

scholarly journals Splenectomy is safe and effective in human immunodeficiency virus- related immune thrombocytopenia [see comments]

Blood ◽  
1993 ◽  
Vol 82 (1) ◽  
pp. 29-32 ◽  
Author(s):  
E Oksenhendler ◽  
P Bierling ◽  
S Chevret ◽  
JF Delfraissy ◽  
Y Laurian ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cell Count ◽  
Immune Thrombocytopenia ◽  
Multiple Regression Model ◽  
Progression Rate ◽  
Free Survival ◽  
Cd4 Cell Count ◽  
Immunodeficiency Virus ◽  
The Mean ◽  
Cd4 Cell

Sixty-eight patients, followed in a prospective cohort study of 185 human immunodeficiency virus (HIV)-infected patients with severe immune thrombocytopenia (platelets < 50 x 10(9)/L), underwent splenectomy, 2 to 41 months (median: 10 months) after immune thrombocytopenic purpura (ITP) was diagnosed. The mean platelet count increased from 18 x 10(9)/L to 223 x 10(9)/L with a persistent increase in 56 (82%). It also led to a significant increase of the mean CD4 cell count from 475 x 10(6)/L to 725 x 10(6)/L within a mean delay of 10 months. In the whole cohort, with a mean follow-up of 63 months (range, 6 to 126), the 5-year estimated rate for progression to acquired immunodeficiency syndrome (AIDS) was 23% (95% confidence interval [CI], 15% to 31%) and the AIDS-free survival was 69% (95% CI, 61% to 77%). To investigate the potential impact of splenectomy, a Cox's multiple regression model was used; as splenectomy was not randomly assigned, it was incorporated as a time-dependent covariate. After adjustment on the CD4 cell count, no statistically significant differences were observed between the splenectomized and the nonsplenectomized patients: AIDS progression rate (P = 0.23), survival (P = 0.64) and AIDS-free survival (P = 0.72) were not influenced by splenectomy. Splenectomy is both effective and safe in the treatment of severe, refractory ITP associated with HIV infection.

scholarly journals Frequency of Cytomegalovirus Viral Load in Iranian Human Immunodeficiency Virus-1-Infected Patients with CD4+ Counts <100 Cells/mm3

Intervirology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Mohammad Reza Jabbari ◽  
Hoorieh Soleimanjahi ◽  
Somayeh Shatizadeh Malekshahi ◽  
Mohammad Gholami ◽  
Leila Sadeghi ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Cell Count ◽  
Previous History ◽  
Cd4 Count ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Hiv 1

<b><i>Objectives:</i></b> The aim of present work was to assess cytomegalovirus (CMV) viremia in Iranian human immunodeficiency virus (HIV)-1-infected patients with a CD4+ count &#x3c;100 cells/mm<sup>3</sup> and to explore whether CMV DNA loads correlate with CD4+ cell counts or associated retinitis. <b><i>Methods:</i></b> This study was conducted at the AIDS research center in Iran on HIV-1-infected patients with CD4+ count &#x3c;100 cells/mm<sup>3</sup>, antiretroviral therapy-naive, aged ≥18 years with no previous history of CMV end-organ disease (CMV-EOD). <b><i>Results:</i></b> Thirty-nine of 82 patients (47.56%) had detectable CMV viral load ranging from 66 to 485,500 IU/mL. CMV viral load in patients with retinitis ranges from 352 to 2,720 IU/mL, and it was undetectable in 2 patients. No significant associations between CMV viremia and CD4+ cell count was found (<i>p</i> value = 0.31), whereas significant association of CMV viremia in HIV-infected patients with retinitis was found (<i>p</i> &#x3c; 0.02). <b><i>Conclusions:</i></b> We estimated the frequency of CMV viral load infection in Iranian HIV-1-infected patients with a CD4+ cell count &#x3c;100 mm<sup>3</sup>/mL in the largest national referral center for HIV-1 infection in Iran. Further research is required on the relevance of CMV viral load in diagnostic and prognostic value of CMV-EOD.

scholarly journals RISK FACTORS FOR THE DEVELOPMENT OF NON-HODGKIN’S LYMPHOMA IN PATIENTS WITH HIV AND HEPATITIS С COINFECTION

2013 ◽  
Vol 18 (5) ◽  
pp. 4-8
Author(s):  
E. L Melnikova ◽  
E. V Volchkova ◽  
E. V Ivannikov ◽  
A. Ya Olshansky ◽  
V. N Vdovina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Viral Load ◽  
Cell Count ◽  
Hodgkin's Lymphoma ◽  
Virologic Suppression ◽  
Hiv Viral Load ◽  
Cd4 Cell Count ◽  
The Mean ◽  
Hcv Coinfection ◽  
Cd4 Cell

The objective of the study was to investigate risk factors for the development of non-Hodgkin's lymphoma (NHL) in HIV-infected patients with hepatitis С virus (HCV) coinfection. A total of 37 HIV-positive subjects with NHL treated in the Moscow Center for Prevention and Control of AIDS between 2009 and 2013 were included in the study. HIV patients were divided into 2 groups: 23 cases with HCV coinfection and 14 patients without HCV coinfection. At the time of making the diagnosis of NHL 90% of patients had CD4 cell count < 350 cell/mm 3. The mean CD4 cell count in the first group (120±123 cell/mm 3) was significantly lower (p=0,035), than in patients without HCV coinfection (267±253 cell/mm3). At the time of making the diagnosis of NHL 70% of patients had HIV viral load ≥5,00 log10. The mean viral load was 5,47±1,09 log10 copies/ml in the first group and 4,06±2,03 log10 copies/ml in the second group (p=0,033). At the time of making the diagnosis of NHL 78% of patients did not receive combination antiretroviral therapy (cART). In most patients who received cART virologic suppression unsufficient and CD4 cell count remained to be low. Risk factors associated with an increased risk of NHL in HIV-infected patients with HCV coinfection are low CD4 cell count, high HIV viral load and lack of effective cART. Timely initiation of cART followed by complete virologic suppression and CD4 recovery are key factors to prevent NHL in HIV-infected patients.

scholarly journals Hepatitis C treatment uptake and response among human immunodeficiency virus/hepatitis C virus-coinfected patients in a large integrated healthcare system

2019 ◽  
Vol 30 (7) ◽  
pp. 689-695 ◽  
Author(s):  
Jennifer O Lam ◽  
Leo B Hurley ◽  
Scott Chamberland ◽  
Jamila H Champsi ◽  
Laura C Gittleman ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Drug Abuse ◽  
Cell Count ◽  
Hcv Treatment ◽  
Cd4 Cell Count ◽  
Treatment Uptake ◽  
Immunodeficiency Virus ◽  
Cd4 Cell

U.S. guidelines recommend that patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and outcomes. We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over three years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) versus commercial insurance (adjusted rate ratio [aRR] = 0.62, 95% CI = 0.46–0.84), patients with drug abuse diagnoses (aRR = 0.72, 95% CI = 0.54–0.97), patients with CD4 cell count <200 cells/µl versus ≥500 (aRR = 0.45, 95% CI = 0.23–0.91), and patients without prior HCV treatment (aRR = 0.68, 95% CI = 0.48–0.97). There were no significant differences in DAA initiation by age, gender, race/ethnicity, socioeconomic status, HIV transmission risk, alcohol use, smoking, fibrosis level, HIV RNA levels, antiretroviral therapy use, hepatitis B infection, or number of outpatient visits. Ninety-five percent of patients achieved sustained virologic response (SVR). We found little evidence of sociodemographic disparities in DAA initiation among HIV/HCV-coinfected patients, and SVR rates were high. Efforts are needed to increase DAA uptake among coinfected Medicare enrollees, patients with drug abuse diagnoses, patients with low CD4 cell count, and patients receiving first-time HCV treatment.

scholarly journals Human Immunodeficiency Virus Type 1 Disease Progression, CCR5 Genotype, and Specific Immune Responses

1998 ◽  
Vol 5 (4) ◽  
pp. 463-466 ◽  
Author(s):  
Ubaldo Visco-Comandini ◽  
Catharina Hultgren ◽  
Christina Broström ◽  
Markus Birk ◽  
Soo Kim ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Immune Responses ◽  
Cell Count ◽  
Disease Progression ◽  
Wild Type ◽  
Cd4 Cell Count ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Hiv 1

ABSTRACT The correlation among the presence of a 32-bp deletion in the CC-chemokine receptor 5 (CCR5) gene, disease progression, and human immunodeficiency virus type 1 (HIV-1)-specific immune responses was analyzed for a cohort of 79 Caucasian HIV-1-infected patients. The CCR5 genotype (CCR5/CCR5 = wild type/wild type or Δ32CCR5/CCR5 = 32-bp deletion/wild type) in peripheral blood mononuclear cells was determined by PCR, followed by sequencing of both wild-type and Δ32CCR5 gene fragments. HIV-1-specific humoral responses to gp41 and V3MN peptides were determined by enzyme immunoassays. The prevalence of the Δ32CCR5 allele was lower among 37 patients with rapid progression (progression to AIDS or to a CD4 cell count of <200 × 106/liter in less than 9 years; P < 0.01) compared to that for 42 patients with slow progression (no AIDS and CD4 cell count of >200 × 106/liter after at least 9 years from infection) or to that for 25 non-HIV-1-infected Swedish blood donors (P < 0.05). No differences were observed in the wild-type CCR5sequences between the different groups of patients. For three analyzed patients, the 32-bp Δ32CCR5 gene deletions were identical. The antibody titers against gp41 and a V3MNpeptide in patients with the Δ32CCR5/CCR5 genotype were not significantly different from those in pair-matchedCCR5/CCR5 controls. However, in 13 analyzed patients, a stronger serum neutralizing activity was associated with the Δ32CCR5/CCR5 genotype. Thus, a CCR5/CCR5genotype correlates with a shortened AIDS-free HIV-1 infection period and possibly with a worse neutralizing activity, without an evident influence on the antibody response to two major antigenic regions of HIV-1 envelope.

scholarly journals Linear Mixed Modeling of CD4 Cell Counts of HIV-Infected Children Treated with Antiretroviral Therapy

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Belay Belete Anjullo ◽  
Derbachew Asfaw Teni
Keyword(s):  
Cell Count ◽  
Stage Iv ◽  
Observation Time ◽  
Square Root ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
History Of ◽  
The Mean ◽  
Cd4 Cell

Background. Human immunodeficiency virus (HIV) is a major health problem in the world, and failure to implement prevention programs results in an increased number of infections among newborns. The goal of this study was to investigate the evolution and determinants of cluster of differentiation four (CD4) cell count among HIV-infected children who were under antiretroviral therapy (ART). Methods. We follow up a cohort of 201 children aged under fifteen years from October 2013 to March 2017 at Adama Hospital in Ethiopia. To get insight into the data, exploratory data analysis was performed on the change in the longitudinal CD4 cell count. Results. At the baseline, the average number of CD4 cell counts was 468.5 cells/mm3 of blood with a standard deviation of 319.11 cells/mm3. Here, we employed the random intercept and the random slope linear mixed-effects model to analyze the data. Among predictor variables, observation time, baseline age, WHO clinical stage, the history of tuberculosis (TB), and functional status were determinant factors for the mean change in the square root of the CD4 cell count. Conclusions. The finding revealed that the change in the square root of the CD4 cell count increases with an increment of age at diagnosis. Regarding WHO clinical stages of patients, those who were in stage III and stage IV of the HIV/AIDs disease stages relatively had lower CD4 cell counts than stage I patients. This shows the change in the square root of CD4 cell counts of stage III and stage IV patients was 6.43 and 9.28 times lower than stage I patients, respectively. Similarly, we noticed that observation time, the history of TB, and functional status were significantly associated with the mean change in the square root of the CD4 cell count.

scholarly journals Bone and joint tuberculosis in patients undergoing dialysis: clinical features, risk factors, and outcomes in 17 patients

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094550
Author(s):  
Xuehua Wu ◽  
Jing Liu ◽  
Guorong Wang ◽  
Fengfeng Wu
Keyword(s):  
Risk Factors ◽  
Cell Count ◽  
Clinical Features ◽  
Medical Records ◽  
Delayed Diagnosis ◽  
Cd4 Cell Count ◽  
Spine Tuberculosis ◽  
The Mean ◽  
Anti Tubercular Therapy ◽  
Cd4 Cell

Objective This study was performed to investigate the clinical features, risk factors, and outcomes of bone and joint tuberculosis in patients undergoing dialysis. Methods We systematically reviewed the medical records of 17 patients with bone and joint tuberculosis undergoing dialysis who were admitted to our hospital from January 2009 to January 2019. Results Seventeen patients with bone and joint tuberculosis undergoing dialysis were identified in this retrospective study, and 13 patients were undergoing hemodialysis. The mean age of the 17 patients was 61.3 years (range, 32–82 years), and 10 (58.9%) patients were male. Most of the patients had a low CD4+ cell count and low hemoglobin and albumin levels. Surgery was performed in 6 patients (35.3%), and 13 of the 17 patients (76.4%) were cured. Three patients had bone or spine sequelae, mainly because of a delayed diagnosis, and one patient died of heart failure. Conclusion These findings indicate that older age, a low CD4+ cell count, and low hemoglobin and albumin levels are possible risk factors for bone and spine tuberculosis in patients undergoing dialysis. If diagnosed early, most patients should have a good outcome after anti-tubercular therapy with or without surgery.

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