HIV/Malaria interaction; how do the two affect the lymphocyte subsets

Dear All,

Just to bring your attention to a paper that will be published shortly in the forthcoming JACI edition. Although this paper mainly dwells much on how these values may affect recommendations in the African setting, they could also have an impact on how malaria would affect these numbers in acute infection. Copied below is the JACI Media summary for this paper for those who might be interested.

regards

wilson mandala

Lymphocyte subsets in healthy Malawians – implications for immunological assessment of HIV infection in Africa

Wilson L. Mandala PhD, Jenny M MacLennan, MRCP, MRCPCH, Esther N. Gondwe, BSc, Steven A Ward, PhD, Malcolm E Molyneux, FMedSci, Calman A MacLennan, DPhil, FRCPath

T cell counts: Doctors must compare apples to apples in the assessment of HIV infection.

HIV/AIDS is a devastating disease resulting from a virus that suppresses the human immune system, leaving it with little defense against a range of infections. In sub-Saharan Africa, the numbers of HIV-infected individuals are considerable. There, antiretroviral therapy (ART) is increasingly used to manage HIV-infected individuals. In these African regions with limited health care resources, medical decisions determining who is eligible for ART are often based on determining the stage of HIV/AIDS the patient is in. This is most often done by clinical staging supplemented, when available, by measuring the percent of T cells (specifically, CD4+ T lymphocytes) in a patient’s blood. Currently, however, there is not enough medical information about normal T cell counts in the peoples of these regions to have a dependable reference for judging the actual extent of HIV’s suppression of the immune system. In an upcoming issue of the Journal of Allergy and Clinical Immunology, found online now at www.jacionline.org, Mandala and colleagues report on their study of the variations in lymphocyte counts in a group of healthy individuals of different ages from Malawi. Blood samples from 539 Malawians who were not infected with HIV were collected and analyzed. The authors found that CD4+T lymphocyte counts (CD4 counts) in Malawian adults are similar in number to those from adults in developed countries, while CD4 counts in Malawian children 3 years old or younger are comparatively lower that in children from developed countries. They also found CD4 counts to be higher in Malawian females than in Malawian males. These findings are an important alert that should be considered when assessing the severity of immunosuppression in HIV-infected African children. The authors advise that to prevent misinterpretation of the state of HIV/AIDS disease, clinicians need to consider physical signs and symptoms even when CD4+ T lymphocyte counts are available when assessing the severity of HIV-related immunodeficiency in African children. Further studies are needed elsewhere in Africa to confirm whether low CD4+ T lymphocyte counts found in children not infected with HIV are a consistent finding throughout the continent. Gender variations should also be investigated further to determine whether higher values in females occur at all ages.