నైరూప్య

Is only reduction in CD4 Count responsible for Secondary Infections seen in HIV patients ?

Rajeev Shah and Aarjav Shah

 The significant mean CD4 count fall had been observed both in HIV positive patients as well as even with the patients of severe tuberculosis without  HIV infections.. But  it has been observed  that  generally, the patients with tuberculosis does not seem to suffer that much  from any secondary or opportunistic microbial infections, while in contrast, the HIV patients with same mean CD4 count suffer  from plenty of opportunistic or secondary  infections.  Aim: Emphasizing the pivotal role of CD4 count in TB/HIV patients in maintaining their immune system effective (by maintaining CD4 count) and thus decreasing MDR/XDR, morbidity and mortality among  these patients. Calculating average mean CD4 count  for  Indian scenario  in cART era. Discussing and suggesting new scope of treating HIV patients for prevention of secondary infections.  Material and methods: All the 961 HIV infected patients early morning sputa  were screened for AFB and few of the samples were even cultured on LJ medium.  All patients’ CD4 count were also evaluated by flow cytomerty method within one week of sputa collection. Seven other published work of HIV/TB patients were analyzed  in relation to CD4 count. Moreover other five published research  on  CD4 in TB+ve/HIV-ve  patients  were also discussed in this article. Results: Out of  961 patients with  HIV/RTI ,  308(32.06%) found positive for tuberculosis with  mean CD4 count  found to be 198.5 and 105.9 cells/μl  for pulmonary  TB  and for extra-pulmonary TB respectively in present study. The average mean CD4 count  from seven research studies from India  were found to be 169.75  and 145.3 cells/μl  for pulmonary and extra-pulmonary TB respectively, in TB/HIV co-infected patients on  cART.  Brenda etal.(1997)  and other four  found that  in advanced/ sever  TB but HIV-negative  patients mean CD4 count found to be 341+116. It means in severe tuberculosis patients CD4 count may reduce up to 198 cells/ μl but in TB patients, But the difference between HIV and TB patients found by researchers was the   CD4:CD8 ratio which always almost maintained in TB patients only but not in HIV patients. Even some researchers like MA Hauman, Fiske CT et al,(2015) could not find increased intracellular bacterial infections (ICBIs)  in  only TB patients(HIV-ve). Conclusion: HAART  and ATT both are equally important in maintaining immune system(maintaining CD4 count)  of TB/HIV co-infected patients. In India, clinician should  more suspect  for TB at around   mean CD4 count of  169.75  even if found negative by AFB staining for, but should be confirmed  by culture on LJ medium, PCR or by any other Latest technique   in HIV-positive patients. It is not only reduced CD4 count responsible for secondary infections seen in HIV patients but it might be  spoiled CD4:CD8 ratio, or in other world increased CD8 cells in comparison with CD4 cells might be responsible for secondary infections seen in HIV patients, to confirm this further research should be done. If it is due to  only this reason in severe TB with CD4 count below 200 cells/μl also secondary infections are usually not seen, then if we  maintain CD4:CD8 ratio in HIV patients, by giving anti-antibodies to CD8 appropriately or by any other methods,  it should  theoretically reduce/stop secondary  or opportunistic infections  in HIV patients also. Further intensive practical research is required  to find out new scope to reduce/stop secondary infections in HIV patients in this direction.