Testing & health monitoring

Low CD4 counts common in HIV-neg intensive care patients

Keith Alcorn
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Relying on a CD4 count as a marker of potential HIV infection in untested individuals may be misleading, according to intensive care clinicians at the University of Pennsylvania.

They reviewed 53 HIV-negative patients admitted to their intensive care unit during 1996 and 1997, and found that 17% had CD4 counts below 200, the level normally associated with a diagnosis of AIDS.

The mean CD4 count was 510, just 10 cells above the recommended threshold for starting antiretroviral therapy in the United States. CD4+/CD8+ ratios were normal, unlike in cases of HIV-related immunosuppression.

Glossary

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

gastrointestinal (GI) symptoms

Relating to or affecting the gut, stomach or bowel. GI symptoms include diarrhoea, abdominal pain (cramps), constipation, gas in the gastrointestinal tract, nausea, vomiting and GI bleeding. Among several possible causes of GI symptoms are infections and antiretroviral medicines.

 

end-stage disease

Final period or phase in the course of a disease leading to a person's death.

AIDS defining condition

Any HIV-related illness included in the list of diagnostic criteria for AIDS, which in the presence of HIV infection result in an AIDS diagnosis. They include opportunistic infections and cancers that are life-threatening in a person with HIV.

consent

A patient’s agreement to take a test or a treatment. In medical ethics, an adult who has mental capacity always has the right to refuse. 

Acute illnesses included severe infections (although not opportunistic infections classified as AIDS-defining), end-stage liver disease, drug overdose, pancreatitis and gastrointestinal bleeding. The median age of participants was 56. A CD4 count below 200 cells on admission was associated with a 2.4-fold increased risk of death.

The results led the University of Pennsylvania team to conclude that "CD4 count should not be relied on for a presumptive diagnosis of HIV in lieu of consent for serologic testing".

Reference

Aldrich J et al. The effect of acute severe illness on CD+ lymphocyte counts in nonimmunocompromised patients. Archives of Internal Medicine 160 (5), 2000

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