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Abstract
Background
In patients with HIV, CD4+ T cell count and viral load are the main laboratory tests performed to assess clinical management. However, they require extensive resources. In this study, we aimed to determine whether hematological parameters measured using a hematology analyzer are useful as surrogate markers of CD4+ T cell count and viral load in HIV-infected patients.
Methods
Peripheral blood samples were obtained from 14 HIV-naïve, 105 HIV-treated, and 103 uninfected individuals. Hematological parameters were measured using the ADVIA 2120i hematology analyzer (Siemens Healthcare Diagnostics, USA).
Results
In HIV-naïve and -treated patients, the percentage of large unstained cells (%LUCs) was 2.5±1.6% and 1.9±0.7%, respectively, compared to 1.6±0.5% in HIV-uninfected controls. The %LUCs was higher in HIV patients with low CD4+ T cell count below 200/μL (2.4±1.0%) or high viral load ≥200 copies/mL (2.4±0.8%) than in other infected groups. Significant differences in lymphocyte count were observed between the HIV-naïve (1.5±0.6×109/L) and uninfected (2.0±0.6×109/L) groups as well as between HIV patients with CD4+ T cells ≥500/μL (2.5±0.6×109/L) and other infected groups. Neutrophil count varied between high viral load (3.0±1.4×109/L) and low viral load (3.7± 1.3×109/L) groups. The CD4+ T cell count correlated with lymphocyte count (r=0.642, P<0.0001) and %LUCs (r=-0.287, P=0.002).
REFERENCES
1. Deeks SG. Immune dysfunction, infammation, and accelerated aging in patients on antiretroviral therapy. Top HIV Med. 2009; 17:118–23.
2. Ipp H, Zemlin AE, Erasmus RT, Glashoff RH. Role of infammation in HIV-1 disease progression and prognosis. Crit Rev Clin Lab Sci. 2014; 51:98–111.
3. Haas A, Zimmermann K, Oxenius A. Antigen-dependent and -independent mechanisms of T and B cell hyperactivation during chronic HIV-1 infection. J Virol. 2011; 85:12102–13.
4. Vanker N, Ipp H. Large unstained cells: a potentially valuable parameter in the assessment of immune activation levels in HIV infection. Acta Haematol. 2014; 131:208–12.
5. Appay V, Sauce D. Immune activation and infammation in HIV-1 infection: causes and consequences. J Pathol. 2008; 214:231–41.
6. Silvestri G, Sodora DL, Koup RA, Paiardini M, O'Neil SP, McClure HM, et al. Nonpathogenic SIV infection of sooty mangabeys is characterized by limited bystander immunopathology despite chronic high-level viremia. Immunity. 2003; 18:441–52.
7. Liu Z, Cumberland WG, Hultin LE, Kaplan AH, Detels R, Giorgi JV. CD8+ T-lymphocyte activation in HIV-1 disease refects an aspect of pathogenesis distinct from viral burden and immunodefciency. J Acquir Immune Defc Syndr Hum Retrovirol. 1998; 18:332–40.
8. Hazenberg MD, Otto SA, van Benthem BH, Roos MT, Coutinho RA, Lange JM, et al. Persistent immune activation in HIV-1 infection is associated with progression to AIDS. AIDS. 2003; 17:1881–8.
9. Buttarello M, Plebani M. Automated blood cell counts: state of the art. Am J Clin Pathol. 2008; 130:104–16.
10. Vanker N, Ipp H. The use of full blood count and differential parameters to assess immune activation levels in asymptomatic, untreated HIV infection. S Afr Med J. 2013; 104:45–8.
11. Lalama CM, Jennings C, Johnson VA, Coombs RW, McKinnon JE, Bremer JW, et al. Comparison of three different FDA-approved plasma HIV-1 RNA assay platforms confrms the virologic failure endpoint of 200 copies per milliliter despite improved assay sensitivity. J Clin Microbiol. 2015; 53:2659–66.
12. Takubo T, Kubota Y, Oguma S, Ueda T, Shibata H, Nakamura H, et al. Classifcation of acute non-lymphocytic leukemia according to the distribution picture of peroxidase activity and cell size: correlation between the classifcation and therapeutic response. Blood Cells. 1983; 9:501–14.
13. Lanza F, Moretti S, Letorraca A, Scapoli G, Rigolin F, Castoldi G. Flow cytochemical analysis of peripheral lymphocytes in chronic B-lymphocytic leukemia. Prognostic role of the blast count determined by the H∗1 system and its correlation with morphologic features. Leuk Res. 1992; 16:639–46.
14. Nixon DF, Parsons AJ, Eglin RP. Routine full blood counts as indicators of acute viral infections. J Clin Pathol. 1987; 40:673–5.
15. Shin D, Lee MS, Kim do Y, Lee MG, Kim DS. Increased large unstained cells value in varicella patients: A valuable parameter to aid rapid diagnosis of varicella infection. J Dermatol. 2015; 42:795–9.
16. Obirikorang C, Yeboah FA. Blood haemoglobin measurement as a predictive indicator for the progression of HIV/AIDS in resource-limited setting. J Biomed Sci. 2009; 16:102.
17. Mocroft A, Kirk O, Barton SE, Dietrich M, Proenca R, Colebunders R, et al. Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. EuroSIDA study group. AIDS. 1999; 13:943–50.
18. Schreibman T, Friedland G. Use of total lymphocyte count for monitoring response to antiretroviral therapy. Clin Infect Dis. 2004; 38:257–62.
19. Gougeon ML, Lecoeur H, Dulioust A, Enouf MG, Crouvoiser M, Gou-jard C, et al. Programmed cell death in peripheral lymphocytes from HIV-infected persons: increased susceptibility to apoptosis of CD4 and CD8 T cells correlates with lymphocyte activation and with disease progression. J Immunol. 1996; 156:3509–20.
20. Levine AM, Karim R, Mack W, Gravink DJ, Anastos K, Young M, et al. Neutropenia in human immunodefciency virus infection: data from the women's interagency HIV study. Arch Intern Med. 2006; 166:405–10.
21. Dalela G, Baig VN. Correlation between total leukocyte count, absolute lymphocyte count, hemoglobin, erythrocyte sedimentation rate and CD4 count in HIV/AIDS patients. Int J Curr Microbiol App Sci. 2015; 4:366–71.
22. Chen J, Li W, Huang X, Guo C, Zou R, Yang Q, et al. Evaluating total lymphocyte count as a surrogate marker for CD4 cell count in the management of HIV-infected patients in resource-limited settings: a study from China. PLoS One. 2013; 8:e69704.
Table 1.
Clinical characteristics and laboratory findings among HIV-treated, -naïve, and uninfected groups
| HIV-unin-fected (N=103) | HIV-treated (N=105) | HIV-naïve (N=14) | P value | |
|---|---|---|---|---|
| Male:Female | 91:12 | 93:12 | 14:0 | 0.404 |
| Age (yr) | 43.1±11.5 | 44.1±13.6 | 38.4±12.5 | 0.315 |
| Hb (g/dL) | 15.1±1.1 | 14.7±1.7 | 14.0±1.9∗ | 0.071 |
| Leukocyte count (×109/L) | 6.0±1.5 | 6.3±1.8 | 5.6±1.5 | 0.181 |
| ANC (×109/L) | 3.3±1.2 | 3.6±1.4 | 3.5±1.5 | 0.251 |
| ALC (×109/L) | 2.0±0.6 | 2.0±0.8 | 1.5±0.6∗† | 0.011 |
| LUCs (%) | 1.6±0.5 | 1.9±0.7∗ | 2.5±1.6∗† | 0.005 |
| Platelet count (×109/L) | 239.0±44.5 | 227.4±72.1 | 224.5±76.8 | 0.162 |
| CD4+ T cell count (/μL) | 496.1±289.2 | 283.1±181.8 | 0.006 | |
| HIV viral load (×103 copies/mL) | 23.0±142.1 | 77.6±297.8 | <0.0001 |
Table 2.
Hematological parameters and HIV viral load among groups according to the CD4+ T cell count in HIV-treated patients
| CD4+ T cell count (/μL) | P value | |||
|---|---|---|---|---|
| <200 (N=18) | 200–499 (N=38) | ≥500 (N=49) | ||
| Hb (g/dL) | 13.8±1.1∗† | 15.0±1.6 | 14.9±1.8 | 0.004 |
| Leukocyte count (×109/L) | 5.4±2.6∗ | 6.0±1.5∗ | 7.0±1.4 | 0.0005 |
| ANC (×109/L) | 3.4±2.0 | 3.5±1.3 | 3.7±1.2 | 0.139 |
| ALC (×109/L) | 1.3±0.9∗ | 1.7±0.5∗ | 2.5±0.6 | <0.0001 |
| LUCs (%) | 2.4±1.0∗† | 1.8±0.7 | 1.8±0.5 | 0.003 |
| Platelet count (×109/L) 2 | 222.4±119.7 | 216.5±68.4 | 237.6±48.9 | 0.091 |
| HIV viral load (×103 copies/mL) | 93.9±314.5∗ | 14.0±50.7∗ | 0.4±2.8 | <0.0001 |
Table 3.
Hematological parameters and CD4+ T cell count between groups according to the HIV viral load in HIV-treated patients
Table 4.
Correlation between hematological parameters and established markers in 119 patients with HIV
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