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Idiopathic CD4+ T-lymphocyte depletion in a west African population
G Djomand1, L Diaby, J M N'Gbichi
1Projet RETRO-CI, Centre Hospitalier de Treichville, Abidjan, Côte d'Ivoire.
Insights
CD4+ T-lymphocyte depletion is uncommon in HIV-negative West Africans, but more frequent in those with tuberculosis or hospitalized. This depletion was not linked to AIDS-like illnesses or increased mortality in HIV-negative individuals.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- CD4+ T-lymphocyte depletion is a hallmark of HIV/AIDS.
- Assessing CD4+ T-lymphocyte counts in HIV-negative populations is crucial for understanding immune status in West Africa.
- Previous studies have not fully elucidated the prevalence and implications of CD4+ T-lymphocytopenia in non-HIV infected individuals in this region.
Purpose of the Study:
- To determine the frequency of CD4+ T-lymphocyte depletion in specific West African populations.
- To investigate the association between AIDS-like illnesses (wasting syndrome) and CD4+ T-lymphocytopenia in HIV-negative individuals.
- To differentiate immune deficiencies related to HIV infection from other causes.
Main Methods:
- Retrospective analysis of CD4+ T-lymphocyte counts from 1991-1992.
- Prospective case-control study in 1992.
- Inclusion of hospitalized medical patients, tuberculosis outpatients, and women in an HIV mother-to-child transmission study in Abidjan, Côte d'Ivoire.
Main Results:
- CD4+ T-lymphocyte counts below 300 x 10(6)/l were found in 9.6% of HIV-negative hospitalized patients, 4.2% of tuberculosis patients, and 0.4% of healthy women.
- No association was found between CD4+ T-lymphocyte depletion and wasting syndrome in HIV-negative individuals.
- Wasting, not CD4+ T-lymphocyte depletion, was associated with increased mortality in HIV-negative individuals; tuberculosis was a common diagnosis in those with wasting and low CD4+ counts.
Conclusions:
- CD4+ T-lymphocytopenia is infrequent (<1%) in asymptomatic HIV-negative West Africans but more common in those with tuberculosis (4%) or hospitalized (10%).
- CD4+ T-lymphocytopenia in HIV-negative individuals was not linked to wasting syndrome or increased mortality.
- The study found no evidence of frequent, clinically significant immune deficiency in West Africa apart from that associated with HIV infection.
Objective:
To assess the frequency of CD4+ T-lymphocyte depletion in selected populations in West Africa and to determine whether an association exists between AIDS-like illnesses and CD4+ T-lymphocytopenia in HIV-negative individuals.
Design:
Retrospective review of databases and prospective case-control study.
Setting:
Project RETRO-CI, an AIDS research project in Abidjan, Côte d'Ivoire, a University Hospital and tuberculosis treatment and maternal and child health centres in Abidjan.
Methods:
We conducted a retrospective review of CD4+ T-lymphocyte counts performed between 1991 and 1992 on hospitalized medical patients, outpatients with tuberculosis, and women participating in a study of HIV-1 and HIV-2 mother-to-child transmission. A prospective case-control study was conducted in 1992 to examine the relationship between HIV-negative CD4+ T-lymphocyte depletion and wasting syndrome (wasting and chronic diarrhoea and/or chronic fever).
Results:
In the retrospective data review, CD4+ T-lymphocyte counts < 300 x 10(6)/l were found in 9.6% of 115 HIV-negative hospitalized patients, in 4.2% of 312 ambulatory tuberculosis patients, and in 0.4% of 263 healthy women after delivery. In the case-control study, no association was found between CD4+ T-lymphocyte depletion in HIV-negative individuals and the presence of wasting syndrome. Increased mortality in HIV-negative individuals was associated with wasting but not with reduced CD4+ T-lymphocyte counts. In contrast, a trend existed for increased mortality with increasingly severe CD4+ T-lymphocyte depletion in HIV-positive patients. Tuberculosis was the most frequently proven or suspected diagnosis in HIV-negative individuals with wasting and CD4+ T-lymphocytopenia.
Conclusions:
In the absence of HIV infection, CD4+ T-lymphocytopenia is uncommon (< 1%) in West African asymptomatic individuals but is more frequent in those with tuberculosis (4%) and hospitalized patients (10%). CD4+ T-lymphocytopenia in HIV-negative individuals was not associated with wasting syndrome or increased mortality. There was no evidence for frequent, clinically relevant immune deficiency other than that associated with HIV infection.
