title: CD4+ T-lymphocyte counts in HIV infection: are European standards applicable to African patients?
abstract: 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.
authors.affiliation: CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: X
authors.initials: X
authors.lastname: Anglaret
authors.forename: S
authors.initials: S
authors.lastname: Diagbouga
authors.forename: E
authors.initials: E
authors.lastname: Mortier
authors.forename: N
authors.initials: N
authors.lastname: Meda
authors.forename: V
authors.initials: V
authors.lastname: Vergé-Valette
authors.forename: F
authors.initials: F
authors.lastname: Sylla-Koko
authors.forename: S
authors.initials: S
authors.lastname: Cousens
authors.forename: G
authors.initials: G
authors.lastname: Laruche
authors.forename: E
authors.initials: E
authors.lastname: Ledru
authors.forename: D
authors.initials: D
authors.lastname: Bonard
authors.forename: F
authors.initials: F
authors.lastname: Dabis
authors.forename: P
authors.initials: P
authors.lastname: Van de Perre
mesh_terms: 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