CD4+ T-lymphocyte counts in HIV infection: are European standards applicable to African patients?
CD4+ lymphocyte count (CD4+ LC) is a widely used marker of Human Immunodeficiency Virus (HIV) immune impairment. Physiological lymphocytosis is frequently encountered in Africans. Therefore, we tried to determine if given CD4+ LC levels are of similar significance in European versus African HIV-infected individuals. Lymphocyte phenotyping of 750 HIV-infected adults was retrospectively analyzed. Three hundred and seventy patients were consecutively selected in Paris, France; 185 in Abidjan, Côte d'Ivoire; and 195 in Bobo-Dioulasso, Burkina Faso. In the three settings, lymphocyte phenotyping was performed by flow cytometry using similar protocols. Data from Abidjan and Bobo-Dioulasso were combined on the basis of geographic proximity and contrasted with those from Paris. Geometric mean levels of Total Lymphocyte Count (TLC), CD4+ LC, CD8+ lymphocyte count (CD8+ LC), and CD4:CD8 ratio, adjusted for percentage of CD4+ T-cells (%CD4+), were compared between Africans and Europeans. For a given %CD4+, TLC and CD4+ LC but not CD8+ LC tended to be about one third higher in West African than in French adults (p < 0.0001). Approximate equivalencies of absolute CD4+ counts in French and West African HIV-infected adults suggest that where thresholds of 200 and 500 CD4+ cells/microliter are applied in Europe, it might be appropriate to apply a threshold of approximately 250 and 700 CD4+ cells/microliter in West Africa, respectively. Establishing indicators of progression of HIV infection with locally appropriate thresholds may represent important steps toward improvement of HIV disease management in Africa.
Anglaret
X
X
CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire.
Diagbouga
S
S
Mortier
E
E
Meda
N
N
Vergé-Valette
V
V
Sylla-Koko
F
F
Cousens
S
S
Laruche
G
G
Ledru
E
E
Bonard
D
D
Dabis
F
F
Van de Perre
P
P
D000328:Adult; D000349:Africa / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D016130:Immunophenotyping; D018655:Lymphocyte Count; D008297:Male; D012189:Retrospective Studies