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Predictors and reference values of CD4 and CD8 T lymphocyte counts in pregnancy: a cross sectional study among HIV
E Gomo1, B J Vennervald, P Ndhlovu
1Blair Research Laboratory, Ministry of Health and Child Welfare, Zimbabwe. exgomo@mweb.co.zw
Objective:
To identify predictors and define reference values for T lymphocyte subsets in HIV negative pregnant black women.
Design:
Cross sectional study.
Setting:
Edith Opperman Martenity Hospital, Harare, Zimbabwe.
Study Population:
1113 HIV negative women 22 to 35 weeks pregnant registering for routine antenatal care.
Methods:
A questionnaire was used to collect demographic and obstetric data. CD4 and CD8 T lymphocyte counts were determined by manual immunocytochemistry. Concentrations in serum, of retinol, beta-carotene, ferritin, folate and 1-antichymotrypsin were also measured. Multiple linear regression analysis was employed to identify and estimate effects of potential predictors.
Main Outcome Measures:
CD4 and CD8 T lymphocyte levels, demographic, obstetric data and micronutrient status.
Results:
Predictors of CD4 counts were gestational age, serum retinol and season. CD4 counts declined by 25 (95% confidence interval [CI]; 11 to 40; p = 0.001) cells/L for each week's increase in gestation among women with low serum retinol, while low serum retinol was independently associated with lower CD4 counts (-127; 95% CI, -233 to 20 cells/L; p = 0.02) at 35 weeks gestation. The late rainy season was associated with higher CD4 counts (137; 95% CI, 67 to 207 cells/L; p < 0.001). CD8 counts were higher in women with low serum folate (87; 95% CI, 6 to 166 cells/L; p = 0.036) and were slightly higher in gravida 4+ compared to gravida one to three. Reference values of CD4 but not CD8 count and percentage markedly differed from flow cytometry values of pregnant and non-pregnant women in developed and developing countries reported in the literature, even after controlling for the differences in methods of T lymphocyte subset immunophenotyping.
Conclusion:
Gestational age, gravidity, micronutrient status and season influence T lymphocyte subset levels and need to be considered when designing clinical management and intervention strategies for pregnant women. The data underscores the need for local reference values.
