Progression of CD4 count among human immunodeficiency virus-seropositive patients in a tertiary care hospital of Tripura, North East India.

Dear Editor,

The estimated number of people living with human immunodeficiency virus (HIV) in India was found to be 20.16 lakh, with an adult HIV prevalence of 0.26%.[1] Tripura is one of the vulnerable states of North East India having an adult HIV prevalence rate of 0.31%.[1] CD4+ count estimation is used as a monitoring tool for disease progression and antiretroviral therapy (ART). This study was conducted to understand the impact of CD4 count progression during ART among HIV patients during follow-ups in the past 5 years (2008–2013). HIV status was confirmed following strategy III of National AIDS Control Organization (NACO). CD4 count was estimated by flow cytometry using BD FACSCount™ (Becton Dickinson) system. CD4 count was measured before starting ART as well as in every 6 months among newly diagnosed cases. Of total 576 newly diagnosed patients during the study period, 261 patients participated in regular follow-up visits. Although the mean CD4 count among healthy population of Tripura is 708 cells/ul,[2] diagnosed HIV patients showed a range of 5–803 cells/ul. 62.5% of registered cases showed a range of 150–249 cells/ul, signifying late treatment initiation along with advance stages of immunosuppression. This study finding is more or less similar to nationally published data of 2004–2005[3] and 2005–2008[4] which showed a CD4 count of <200 cells/mm3 among 75% and 85% of registered cases, respectively, indicating advanced stages of immunosuppression due to delay in diagnosis and access to care. The results of follow-up visits show a continuous increase in CD4 count among 61% (160/261), continuous decrease among 7% (17/261), and fluctuation among 32% (84/261), respectively [Table 1and Figure 1]. 62.5% of the study population had a CD4 count of 150–249 cells/ul at diagnosis, of which mortality was found to be 86%, whereas 7% are nonresponder to first-line ART. A published article from the same institute shows that lower respiratory tract infection is the most common opportunistic infection among seropositive patients. The predominant age was 26–30 years, and Mycobacterium tuberculosis is found to be highest in number, followed by Staphylococcus, Pseudomonas aeruginosa, Klebsiella, and Citrobacter in order of frequency.[5] Thus, this study highlights the importance of early diagnosis and early initiation of ART, which may increase the survival rate and quality of life. More intensified focus to be given in the ongoing control program for active case finding.

Table 1

Trend of CD4 count among 261 patients

CD4 range (at diagnosis)	Continuous increase	Continuous decrease	Fluctuation	Chi-square test (P)
<100	27	1	2	<0.01
100-249	81	4	18
250-399	47	7	32
400-549	5	5	15
550-699	0	0	10
>699	0	0	7

Figure 1

Trend of CD4 count on regular follow-up

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