OBJECTIVE To summarize current information around the relation between CD4 counts
May 9, 2017
OBJECTIVE To summarize current information around the relation between CD4 counts and the risk of different HIV-related diseases. HIV when CD4 is usually below 200/mm 3 Pneumocystis carinii pneumonia toxoplasmosis progressive multifocal leukoencephalopathy Mycobacterium avium complex molluscum contagiosum SB 216763 and bacillary angiomatosis all increase in incidence. In very advanced SB 216763 HIV disease when CD4 counts are below 50/mm SB 216763 3 patients are at risk of pseudomonas pneumonia cytomegalovirus retinitis central nervous system lymphoma aspergillosis and disseminated histoplasmosis. complex lymphoma and CNS. All were combined with the term HIV. Studies were examined for information on CD4 count and correlation with specific diseases. RESPIRATORY DISEASE HIV-infected individuals frequently present with nonspecific respiratory symptoms including cough dyspnea and chest pain. In patients with CD4 counts above 500/mm 3 sinusitis community-acquired pneumonia and viral infections commonly account for these symptoms. Tuberculosis can occur at any CD4 count but it usually occurs when the CD4 count is usually below 500/mm 3. Once the Compact disc4 count number drops below 200/mm 3 the occurrence of pneumonia (PCP) fungal pneumonia and more Rabbit Polyclonal to BRP16. serious types of sinusitis and bacterial pneumonia including those due to is highly recommended. Although seldom causes sinusitis in HIV-seronegative people it may take into account 16% to 18% of situations of sinusitis in HIV-infected people and is connected with a high price of repeated disease.9 10 When the CD4 count is below 150/mm 3 fungal pathogens such as for example should also be looked at.11 Pneumonia Like sinusitis bacterial pneumonia takes place with increased occurrence in HIV-infected individuals. In the cohort of just one 1 281 sufferers examined by Wallace et al. those contaminated with HIV acquired an better incidence of bacterial pneumonia compared to the HIV-seronegative control content eightfold.12 Although bacterial pneumonia may appear at any Compact disc4 count number its occurrence and severity are inversely linked to Compact disc4 matters.13 In a single series the occurrence of bacterial pneumonia in sufferers with Compact disc4 counts significantly less than 250/mm 3 approached the occurrence of PCP.12 Risk elements include CD4 matters significantly less than 200-250/mm 3 cigarette smoking illicit medications 12 14 as well as perhaps intravenous medication use and using tobacco.13 The most frequent pathogen is pneumonia takes place at a mean CD4 count number of 25/mm 3 often in sufferers who absence traditional risk elements for pseudomonas infection such as for example neutropenia indwelling central venous catheters or chronic steroid use. It SB 216763 could present with cavitary infiltrates on upper body radiography and it is associated with a higher relapse price.17 18 However the widespread usage of prophylactic antibodies provides lowered the occurrence of PCP it continues to be a common problem of HIV infections. PCP frequently presents with steadily intensifying dyspnea fever and coughing. It hardly ever happens when the CD4 count is definitely greater than 250/mm 3. In one series Jensen et al. found that only 3 (5%) of 61 instances of PCP occurred with a CD4 count above 250/mm 3.19 Wallace et al. found that only 4 (9%) of 43 individuals with PCP experienced CD4 counts greater than 250/mm 3 and 3 of these 4 had CD4 counts less than 333/mm 3.12 In another series Masur et al. found that only 3 (6%) of 49 individuals with PCP experienced CD4 counts greater than 200/mm 3.20 Risk factors for PCP include CD4 less than 200/mm 3 previous PCP and oral thrush. These as well mainly because unexplained fevers for longer than 2 weeks are indications for instituting PCP prophylaxis. Fungal pneumonia happens in advanced AIDS. Individuals usually have indolent nonspecific symptoms including fever fatigue excess weight loss cough and dyspnea enduring weeks to weeks. Coccidioidomycosis occurs most commonly in the Southwestern claims and in individuals with CD4 counts below 150/mm 3.21 Disseminated histoplasmosis occurs in the Mississippi and Ohio River valleys and in individuals with CD4 counts below 50/mm 3. In a series of 980 individuals with AIDS analyzed by Nightingale et al. those with disseminated histoplasmosis experienced a SB 216763 median CD4 depend of 33/mm 3.22 Aspergillosis is rare and occurs in individuals with CD4 counts below 50/mm 3.23 Risk factors for SB 216763 aspergillosis include neutropenia corticosteroid use and underlying lung disease. can cause pulmonary disease but more commonly causes meningitis (observe Central Nervous System Disease section). Tuberculosis Tuberculosis tends to occur at CD4 counts below 500/mm 3. In a series of 193 HIV-infected sufferers with tuberculosis just 4 (2.1%) had Compact disc4 matters above.