title: CD4+ T-lymphocyte variations in patients with advanced human immunodeficiency virus infection and counts below 100 cells per microliter.
abstract: Variability in CD4+ T-lymphocyte measurements has been described for both normal and human immunodeficiency virus (HIV)-infected persons. Clinical protocols use CD4+ cell counts as surrogate markers for disease progression or response. In this study, we determined the variability of CD4+ T-lymphocytes below 100 cells/microl when measured less than 7 days apart. Two consecutive lymphocyte subset measurements were performed in 55 patients using CD3/CD4 antibodies in a flow cytometer (Epics Profile II). Specimens were collected between 8:00 and 10:00 am within the same week. Data from the first and second measurements were compared. The average total lymphocyte count on the first measurement was 1,064 (360-2,853), and on the second 1,162 (320-2,223; P = 0.07); the percentage CD4 was 1.76 (0-8) on the first, and on the second 1.98 (0-9; P = 0.3); the absolute CD4 cell count on the first measurement was 16.6 (0-57) and on the second 22.8 (0-93; P = 0.01). Statistically significant differences were found between the first and second absolute CD4 T-lymphocytes but not in the CD4 percentage. These differences probably are due to variations in total lymphocyte count. For research protocols, repeating CD4+ cell determinations within a short period is advisable, to ensure a homogeneous population. On the other hand, for day-to-day patient follow-up, a combination of clinical criteria and both percentage and absolute CD4+ cell counts should be used to make treatment decisions, because repeating CD4 cell measurements can be very costly.
authors.affiliation: Instituto Nacional de Cancerología, Mexico City, Mexico.
authors.forename: J
authors.initials: J
authors.lastname: Guarner
authors.forename: P
authors.initials: P
authors.lastname: Montoya
authors.forename: C
authors.initials: C
authors.lastname: del Rio
authors.forename: G
authors.initials: G
authors.lastname: Hernandez-Tepichin
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000379:methods; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D019469:Indinavir / Q000627:therapeutic use; D007958:Leukocyte Count; D018655:Lymphocyte Count; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents; D019469:Indinavir