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A review on peripheral blood CD4+ T lymphocyte counts in healthy adult Indians.

Shete A, Thakar M, Abraham PR, Paranjape R - Indian J. Med. Res. (2010)

Bottom Line: Hence CD4+ T lymphocyte count is the most important marker of immune dysfunction in HIV disease progression.The published data on the CD4+ T cells count in healthy Indian adult population have been reviewed, analyzed and discussed in this review article.The requirement of establishment of reference ranges in Indian population is discussed.

View Article: PubMed Central - PubMed

Affiliation: National AIDS Research Institute (ICMR), Pune, India.

ABSTRACT
The CD4+ T lymphocytes are the crucial cells in the cascade of events in forming immune response to the foreign antigen and hence monitoring the CD4+ T cell counts to understand the extent of immune deficiency is a common practice. CD4+ T cells are also the primary target cells for human immunodeficiency virus (HIV). Hence CD4+ T lymphocyte count is the most important marker of immune dysfunction in HIV disease progression. The estimation of CD4+ T cell counts is used to decide the initiation of anti retroviral therapy (ART), to monitor the efficacy of ART and to start treatment for opportunistic infections (OIs). To develop the threshold levels of CD4+ T cell counts, data from western countries are being used in India. The CD4+ T cell counts are known to be influenced by race and environmental factors. Hence it is important to establish the reference ranges for the CD4+ T cell counts in the target population to understand the immune dysfunction. The information on the lower limits of the CD4+ T cells count is necessary to decide the initiation and monitoring of ART. The published data on the CD4+ T cells count in healthy Indian adult population have been reviewed, analyzed and discussed in this review article. The requirement of establishment of reference ranges in Indian population is discussed.

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Comparison of mean and median absolute CD4 counts in normal healthy individuals as reported from different parts of India: (a) Comparison of mean CD4 counts, (b) comparison of median CD4 counts from different regions of India. Mean/median CD4 counts in cells/µl is plotted on Y axis and studies done in different regions of India are plotted on Xaxis. Red and green colours indicate CD4 values from females and males respectively. The black colours indicate CD4 values irrespective of the gender. The number above each value indicates number of samples tested to get the value in the study. Source of data: Refs. 18, 20, 36, 61, 63-71, 73-76.
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Figure 0001: Comparison of mean and median absolute CD4 counts in normal healthy individuals as reported from different parts of India: (a) Comparison of mean CD4 counts, (b) comparison of median CD4 counts from different regions of India. Mean/median CD4 counts in cells/µl is plotted on Y axis and studies done in different regions of India are plotted on Xaxis. Red and green colours indicate CD4 values from females and males respectively. The black colours indicate CD4 values irrespective of the gender. The number above each value indicates number of samples tested to get the value in the study. Source of data: Refs. 18, 20, 36, 61, 63-71, 73-76.

Mentions: The reported lowest value of CD4+ T cells count varied between 304 to 500 cells/µl and highest CD4+ T cells count varied between 1000 cells/µl to as high as 1864 cells/µl6465 indicating the wide difference that exists in the CD4 reference ranges. The mean CD4+ T cell counts as reported in different Indian studies are illustrated in the Figure. The mean CD4+ T cell counts in the north India varied from as low as 703 to 818 cells/µl6566, in south India from 799 to 1048 cells/µl62676876, 743 to 965 cells/µl2069 in western India and 848 cells/µl70 in eastern India. Although CD4+ T cell counts in south Indian population appear higher than those in north in several studies (Fig.), the CD4+ T cell percentages as reported in the only multicentric study were significantly lower in south Indian population compared with the populations in other parts of the country61. The females have been observed to have higher CD4+ T cell counts and males have higher CD8+ T cell counts in different Indian studies186371. The mean CD4 per cent in different geographical regions of India varied from 32.43 per cent (south Indian population; range 14 to 51%) to 41.15 per cent (population from western India; range 15 to 65%)366164. Overall, mean CD4 per cent has been found to be lower (37.1 ± 7.8) in the Indian multicentre study as compared to 43.0 per cent ±7.5 reported in US population4861. It has been suggested by Lifson et al72 that a ratio below 0.85 should raise the suspicion of high risk behaviour of acquiring HIV. However, the studies conducted in normal Indian populations showed variations in CD4:CD8 ratio from 0.04 to 3.564. The mean CD4: CD8 ratio varied between 0.94 to 1.78 in different studies6773. The ICMR multicentric study has reported a mean CD4:CD8 ratio of 1.2 from the six centers in different locations in India61.


A review on peripheral blood CD4+ T lymphocyte counts in healthy adult Indians.

Shete A, Thakar M, Abraham PR, Paranjape R - Indian J. Med. Res. (2010)

Comparison of mean and median absolute CD4 counts in normal healthy individuals as reported from different parts of India: (a) Comparison of mean CD4 counts, (b) comparison of median CD4 counts from different regions of India. Mean/median CD4 counts in cells/µl is plotted on Y axis and studies done in different regions of India are plotted on Xaxis. Red and green colours indicate CD4 values from females and males respectively. The black colours indicate CD4 values irrespective of the gender. The number above each value indicates number of samples tested to get the value in the study. Source of data: Refs. 18, 20, 36, 61, 63-71, 73-76.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3102453&req=5

Figure 0001: Comparison of mean and median absolute CD4 counts in normal healthy individuals as reported from different parts of India: (a) Comparison of mean CD4 counts, (b) comparison of median CD4 counts from different regions of India. Mean/median CD4 counts in cells/µl is plotted on Y axis and studies done in different regions of India are plotted on Xaxis. Red and green colours indicate CD4 values from females and males respectively. The black colours indicate CD4 values irrespective of the gender. The number above each value indicates number of samples tested to get the value in the study. Source of data: Refs. 18, 20, 36, 61, 63-71, 73-76.
Mentions: The reported lowest value of CD4+ T cells count varied between 304 to 500 cells/µl and highest CD4+ T cells count varied between 1000 cells/µl to as high as 1864 cells/µl6465 indicating the wide difference that exists in the CD4 reference ranges. The mean CD4+ T cell counts as reported in different Indian studies are illustrated in the Figure. The mean CD4+ T cell counts in the north India varied from as low as 703 to 818 cells/µl6566, in south India from 799 to 1048 cells/µl62676876, 743 to 965 cells/µl2069 in western India and 848 cells/µl70 in eastern India. Although CD4+ T cell counts in south Indian population appear higher than those in north in several studies (Fig.), the CD4+ T cell percentages as reported in the only multicentric study were significantly lower in south Indian population compared with the populations in other parts of the country61. The females have been observed to have higher CD4+ T cell counts and males have higher CD8+ T cell counts in different Indian studies186371. The mean CD4 per cent in different geographical regions of India varied from 32.43 per cent (south Indian population; range 14 to 51%) to 41.15 per cent (population from western India; range 15 to 65%)366164. Overall, mean CD4 per cent has been found to be lower (37.1 ± 7.8) in the Indian multicentre study as compared to 43.0 per cent ±7.5 reported in US population4861. It has been suggested by Lifson et al72 that a ratio below 0.85 should raise the suspicion of high risk behaviour of acquiring HIV. However, the studies conducted in normal Indian populations showed variations in CD4:CD8 ratio from 0.04 to 3.564. The mean CD4: CD8 ratio varied between 0.94 to 1.78 in different studies6773. The ICMR multicentric study has reported a mean CD4:CD8 ratio of 1.2 from the six centers in different locations in India61.

Bottom Line: Hence CD4+ T lymphocyte count is the most important marker of immune dysfunction in HIV disease progression.The published data on the CD4+ T cells count in healthy Indian adult population have been reviewed, analyzed and discussed in this review article.The requirement of establishment of reference ranges in Indian population is discussed.

View Article: PubMed Central - PubMed

Affiliation: National AIDS Research Institute (ICMR), Pune, India.

ABSTRACT
The CD4+ T lymphocytes are the crucial cells in the cascade of events in forming immune response to the foreign antigen and hence monitoring the CD4+ T cell counts to understand the extent of immune deficiency is a common practice. CD4+ T cells are also the primary target cells for human immunodeficiency virus (HIV). Hence CD4+ T lymphocyte count is the most important marker of immune dysfunction in HIV disease progression. The estimation of CD4+ T cell counts is used to decide the initiation of anti retroviral therapy (ART), to monitor the efficacy of ART and to start treatment for opportunistic infections (OIs). To develop the threshold levels of CD4+ T cell counts, data from western countries are being used in India. The CD4+ T cell counts are known to be influenced by race and environmental factors. Hence it is important to establish the reference ranges for the CD4+ T cell counts in the target population to understand the immune dysfunction. The information on the lower limits of the CD4+ T cells count is necessary to decide the initiation and monitoring of ART. The published data on the CD4+ T cells count in healthy Indian adult population have been reviewed, analyzed and discussed in this review article. The requirement of establishment of reference ranges in Indian population is discussed.

Show MeSH
Related in: MedlinePlus