Idiopathic CD4+ T-lymphocyte depletion in a west African population.
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.


METHODS
Retrospective review of databases and prospective case-control study.


METHODS
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.
Djomand
G
G
Projet RETRO-CI, Centre Hospitalier de Treichville, Abidjan, Côte d'Ivoire.
Diaby
L
L
N'Gbichi
J M
JM
Coulibaly
D
D
Kadio
A
A
Yapi
A
A
Kanga
J M
JM
Boateng
E
E
Diallo
K
K
Kestens
L
L
D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D015496:CD4-Positive T-Lymphocytes; D016022:Case-Control Studies; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D007958:Leukocyte Count; D008231:Lymphopenia / Q000453:epidemiology*; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies