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CD4 Counts as Predictors of Opportunistic Pneumonias in Human Immunodeficiency Virus (HIV) Infection
- Henry Masur, MD;
- Frederick P. Ognibene, MD;
- Robert Yarchoan, MD;
- James H. Shelhamer, MD;
- Barbara F. Baird, BSN;
- William Travis, MD;
- Anthony F. Suffredini, MD;
- Lawrence Deyton, MD, MPH;
- Joseph A. Kovacs, MD;
- Judith Falloon, MD;
- Richard Davey, MD;
- Michael Polis, MD;
- Julia Metcalf, BA;
- Michael Baseler, PhD;
- Robert Wesley, PhD;
- Vee J. Gill, PhD;
- Anthony S. Fauci, MD; and
- H. Clifford Lane, MD
Abstract
Study Objective: To determine if circulating CD4+ lymphocyte counts are predictive of specific infectious or neoplastic processes causing pulmonary dysfunction.
Design: Retrospective, consecutive sample study.
Setting: Referral-based clinic and wards.
Patients: We studied 100 patients infected with human immunodeficiency virus (HIV) who had had 119 episodes of pulmonary dysfunction within 60 days after CD4 lymphocyte determinations.
Measurements and Main Results: Circulating CD4 counts were less than 0.200 X 109 cells/L (200 cells/mm3) before 46 of 49 episodes of Pneumocystis pneumonia, 8 of 8 episodes of cytomegalovirus pneumonia, and 7 of 7 episodes and 19 of 21 episodes of infection with Cryptococcus neoformans and Mycobacterium avium-intracellulare, respectively. In contrast, circulating CD4 counts before episodes of non-specific interstitial pneumonia were quite variable: Of 41 episodes, 11 occurred when CD4 counts were greater than 0.200 X 109 cells/L. The percent of circulating lymphocytes that were CD4+ had a predictive value equal to that of CD4 counts. Serum p24 antigen levels had no predictive value.
Conclusions: Pneumocystis pneumonia, cytomegalovirus pneumonia, and pulmonary infection caused by C. neoformans or M. avium-intracellulare are unlikely to occur in HIV-infected patients who have had a CD4 count above 0.200 to 0.250 X 109 cells/L (200 to 250 cells/mm3) or a CD4 percent above 20% to 25% in the 60 days before pulmonary evaluation. Patients infected with HIV who have a CD4 count below 0.200 X 109 cells/L (or less than 20% CD4 cells) are especially likely to benefit from antipneumocystis prophylaxis.
Article and Author Information
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From the National Institutes of Allergy and Infectious Diseases and the National Cancer Institute, Bethesda, Maryland; and Program Resources, Inc., Frederick, Maryland. For current author addresses, see end of text.
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Grant Support: Supported in part by the Department of Health and Human Services under contract NO1-CO-74102.
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Requests for Reprints: Henry Masur, MD, Clinical Center 10D48, National Institutes of Health, Bethesda, MD 20892.
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Current Author Addresses: Drs. Masur, Ognibene, Shelhamer, Suffredini, Kovacs, Falloon, Polis, and Ms. Baird: Clinical Center 10D48, National Institutes of Health, Bethesda, MD 20892.
Dr. Yarchoan: Clinical Center 13N248, National Institutes of Health, Bethesda, MD 20892.
Dr. Travis: Clinical Center 2N218, National Institutes of Health, Bethesda, MD 20892.
Dr. Deyton: Clinical Center 11C412, National Institutes of Health, Bethesda, MD 20892.
Dr. Davey: Clinical Center 11C118, National Institutes of Health, Bethesda, MD 20892.
Ms. Metcalf: Clinical Center 11B09, National Institutes of Health, Bethesda, MD 20892.
Dr. Baseler: Building 469, Room 6, NCI-Frederick Cancer Research Facility, PO Box B, Frederick, MD 21701.
Dr. Wesley: Clinical Center 7D41, National Institutes of Health, Bethesda, MD 20892.
Dr. Gill: Clinical Center 2C385, National Institutes of Health, Bethesda, MD 20892.
Dr. Fauci: Building 31, Room 7A03, National Institutes of Health, Bethesda, MD 20892.
Dr. Lane: Clinical Center 11B09, National Institutes of Health, Bethesda, MD 20892.
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