Predictors of CD4+ lymphocyte count among HIV-seropositive and HIV-seronegative pregnant women in Dar es Salaam, Tanzania

Establishment of Immunohematological Reference Values among HIV Sero-negative Pregnant Women at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia

Background

Normal pregnancy is characterized by profound changes in almost every organ and system. Immunohematological parameters are important in clinical practice for the assessment of health and disease. Therefore, this study was aimed to establish immunohematological reference range among HIV sero-negative pregnant women.

Methods

A cross-sectional study was conducted among HIV sero-negative pregnant women at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, from 20/1-30/6/ 2016. Whole blood was collected and immunological and hematological parameters were measured following the standard procedure. Data were entered in to Epi Info version 3.5, checked for completeness and exported to SPSS version 20 software for analysis. The mean ± SD and 95% Confidence Interval (95% CI) values were calculated for different immunohematological parameters.

Results

A total of 400 women with mean age ±SD (27.3 ±4.7) ranging from 18-40 years were enrolled. The mean ± SD reference value of white blood cells count with 95% CI was 8.3 ±2.3 (8.1-8.6) ×10⁹ cells/L and for CD4⁺, CD8⁺, and CD4 to CD8 ratio cells absolute count with 95% CI were 906 ±404 (867-946), 698± 378 (662-736) cell/µl, and 1.5±0.9 (1.4-1.6), respectively.The mean ± SD reference values for red blood cells count with 95% CI was 4.5±0.5(4.4-4.5) 10¹²/L, for hemoglobin 14±7.2(13.3-14.7) gm/dl, and for hematocrite was 39.5± 4(39-39.9).

Conclusions

These values were lower than the one from developed countries but not lower than the one from other African studies. It suggests the need for further large study.

Simple markers for the detection of severe immunosuppression in children with HIV infection in highly resource-scarce settings: experience from the Democratic Republic of Congo

OBJECTIVES

The decision to initiate the antiretroviral therapy in HIV-infected children living in poor countries is compromised by lack of resources. The objective of this study is to identify simple clinical and biological markers other than CD4+ count and viral load measurement that could help the decision to introduce antiretroviral treatment and to monitor patients.

METHODS

A cross sectional study was conducted between January and March 2005 in Kinshasa, Democratic Republic of Congo.

RESULTS

Eighty-four children infected with HIV were recruited. In this cohort, the lymphocytes (P = 0.001) and CD4 (P = 0.0001) were significantly lower in children with immunological stage 3 and viral load (P = 0.027) was significantly higher in children at the same immunological stage. Reticulocytes (r = +0.440), white blood cells count (r = +0.560), total lymphocytes (r = +0.675) and albumin (r = +0.381) showed positive significant correlations with CD4. Haemoglobin (r = - 0.372), Haematocrit (r = - 0.248), red blood cells (r = - 0.278) and CD4 (r = - 0.285) showed negative significant correlations with viral load. Neutropaenia (P = 0.02), enlarged nodes (P = 0.005) and oral candidiasis (P = 0.04) were associated with viral load >10,000 copies/ml. Oral candidiasis (P = 0.02) was associated with CD4 level < 15%.

CONCLUSION

Oral candidiasis, enlarged nodes, total lymphocytes count, neutropaenia and albumin predict severe immunodepression. These clinical and biological markers may guide the clinician in making the decision to initiate antiretroviral therapy in highly resource-scarce settings.