Tehran University Medical Journal

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: CD4 T-Lymphocyte counts have proven to be a standard laboratory marker of disease progression and severity of immunodeficiency in adults infected with HIV is used to initiate and monitor highly active antiretroviral therapy however, its application may not be feasible for its expensive equipments and reagent in resource-limited setting. There is a need to have another marker of immunodeficiency that is less resource-demanding. In April 2002, the World Health Organization (WHO) recommended that, when CD4 cell count is not available, a TLC of 1200cell/mm3 or less in individuals with stage 2 or 3 of the disease may be used as an indication to initiate ART.
Methods: The aim of this study was to determine the relationship between total lymphocyte count and CD4 count in HIV-infected adults. This was a retrospective cross-sectional study. Subject characteristics were patients who had positive serologic HIV test results, confirmed via western blot. Analysis unit was the results of CBC and CD4 measurements on the same blood sample each time. Data of 100 patients were collected. In this study, TLC accounts for the main predictor of CD4 count. The amounts of TLC which can predict CD4 less than 200cell/mm3 were considered eligible.
Results: Our data revealed high sensitivity and specificity of TLC as a surrogate measure of CD4 count. In this study, TLC cutoff of 1300cell/mm³ indicated the optimal combined sensitivity and specificity altogether.
Conclusion: Total lymphocyte count and its changes can be used as alternative to CD4 count and its changes in the management of HIV-infected individuals.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: One of the clinical manifestations of Human Immunodeficiency Virus (HIV) infected patients is cardiovascular disorder. The aim of this study was to evaluate the prevalence of cardiovascular disorders in HIV infected patients for the beginning treatment of these patients and reducing mortality and morbidity in these patients.
Methods: This cross-sectional study was performed on 134 HIV infected patients who referred to Imam Khomeini hospital, Tehran University of Medical sciences, Tehran Iran during years 2007-2008. Demographic characteristics, history of smoking and opium addiction, antiretroviral therapy, class of drugs and duration of consumption were recorded. After completion of physical examination, electrocardiography and echocardiography studies were done.
Results: In this study 98(73.1%) patients were male. The mean age of the patients was 36.5±10.3 years. The mean of the CD4 number were 296±181. Injection drug users were 54.4% of the study patients. Cardiovascular disorders were found in 84(62.7%) patients. Among patients with heart diseases, 75% were male. The most Electrocardiographic change was the axis deviation of the heart found in 32(23.7%) patients. Pericardial effusion and LVEF<50% were noted in 7(5.2%) and 23(17.2%) patients respectively. The involvement of the mitral valve in 59(44%), tricuspid valve in 21(15.7%) and aortic valve in 6(4.5%) patients were noted. Myocardial dysfunctions existed in 10(7.4%) patients.
Conclusions: Our results showed a high prevalence of cardiovascular disorder in HIV infected patients. We recommend the evaluation of the cardiovascular system in all HIV infected patients even if they are symptom free.

Background: After primary infection, the number of CD4 T-cells decreases with disease progress. The patient’s immunological status could inform by The CD4 T-cell counts over the time. The main purpose of this study is to assess the trend of CD4 cell count in HIV+ patient that received Antiretroviral Therapy (ART) by using a multistate Markov model to estimate transition intensities and transition probabilities among various states.

Methods: A total of 122 HIV+ patients were included in this cohort study who are undergoing Antiretroviral Therapy treatment in the Iran AIDS center in Imam Khomeini Hospital in Tehran that inter during March 1995 to January 2005 and then fallow up to October 2014. All adults with at least two follow-up visits in addition to their pre-ART treatment were considered to be eligible for inclusion in the study. Continuous-time Markov processes are used to describe the evolution of a disease over different states. The mean sojourn time for each state was estimated by multi state Markov model.

Results: Sample included 22 (18%) female with a mean age of 43.32 (standard deviation 8.33) years and 100 (82%) male with a mean age of 45.28 (standard deviation 8.34) year. Age was divided in to two categories, 40 years old and lower than that 66 (54.1) patents and persons older than 40 years old 56 (45.9) patents. A total of 122 patients were included. 29 patients died during follow-up. One year transition probability for staying in state 1 of CD4 cell count was 51%. This probability for six year was 33%. The mean sojourn time for sate 4 was 21 month. The hazard ratio of transition from state 3 to state 4 was 4.4 in men related to women.

Conclusion: The use of antiretroviral therapy in the treatment of HIV infected persons reduce viral replication and increase in CD4 T lymphocyte count, and delay the progression of disease. This paper is shown the progression of this trend.