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CDC staging based on absolute CD4 count and CD4 percentage in an HIV-1-infected Indian population: treatment
M Vajpayee1, S Kaushik, V Sreenivas
1Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India. mvajpayee@hotmail.com
Insights
CD4+ T-cell percentage (CD4%) offers crucial insights for classifying HIV clinical stages in Indian adults. Staging by CD4% highlights the need for earlier antiretroviral therapy initiation in treatment-naïve individuals.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- CD4+ T-cell counts are vital for HIV/AIDS staging and management, guiding antiretroviral therapy (ART) and opportunistic infection prophylaxis.
- CD4 counts can be influenced by various factors including geography, race, ethnicity, age, gender, and leukocyte counts.
- The US Centers for Disease Control and Prevention (CDC) classification system relies on CD4 counts for staging HIV-infected individuals.
Purpose of the Study:
- To evaluate the utility of CD4+ T-cell percentage (CD4%) versus absolute CD4 counts for CDC staging in ART-naïve HIV-positive Indian adults.
- To determine if CD4% staging has different clinical implications compared to CD4 count staging in this population.
Main Methods:
- A cohort of 600 HIV-seropositive, ART-naïve Indian individuals were classified into CDC groups A, B, and C.
- Classification was performed using both CD4% and absolute CD4 counts according to CDC criteria.
- Receiver operating characteristic (ROC) curves were generated to compare the staging methods.
Main Results:
- CDC staging based on CD4% revealed significant clinical implications.
- Staging by CD4% suggested a need for earlier ART initiation in certain individuals compared to staging by CD4 counts.
- The study highlights potential differences in clinical management based on the chosen CD4 metric.
Conclusions:
- CD4% is a valuable metric for CDC staging of HIV in Indian adults, potentially identifying individuals who would benefit from earlier ART.
- Relying solely on CD4 counts may underestimate the clinical stage for some patients, delaying necessary treatment.
- Further research is warranted to refine HIV staging criteria using CD4% in diverse populations.
Abstract:
CD4+ T-cell levels are an important criterion for categorizing HIV-related clinical conditions according to the CDC classification system and are therefore important in the management of HIV by initiating antiretroviral therapy and prophylaxis for opportunistic infections due to HIV among HIV-infected individuals. However, it has been observed that the CD4 counts are affected by the geographical location, race, ethnic origin, age, gender and changes in total and differential leucocyte counts. In the light of this knowledge, we classified 600 HIV seropositive antiretroviral treatment (ART)-naïve Indian individuals belonging to different CDC groups A, B and C on the basis of CDC criteria of both CD4% and CD4 counts and receiver operating characteristic (ROC) curves were generated. Importantly, CDC staging on the basis of CD4% indicated significant clinical implications, requiring an early implementation of effective antiretroviral treatment regimen in HIV-infected individuals deprived of treatment when classified on the basis of CD4 counts.
