Poor CD4 Count Is a Predictor of Untreated Depression in HIV-Positive African-Americans

AIM:

To determine if efforts to improve antiretroviral therapy (ART) adherence minimizes the negative impact of depression on human immunodeficiency virus (HIV) outcomes.

METHODS:

A cross-sectional study of a clinic-based cohort of 158 HIV seropositive (HIV+) African Americans screened for major depressive disorder (MDD) in 2012. CD4 T lymphocyte (CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count (< 350 cells/mm(3)). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders.

RESULTS:

Out of 147 individuals with available CD4+ T lymphocyte data, 31% hadCD4+ count < 350 cells/mm(3) and 28% reported poor ART adherence. As expected the group with > 350 cells/mm(3) CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm(3) CD4+ T lymphocyte count (P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group.

CONCLUSION:

Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients

Demographic and behavioral characteristics of study participants with or without depression

Characteristics	No MDD	MDD treated	MDD untreated	P
	(n = 89)	(n = 38)	(n = 20)
	(%)	(%)	(%)
Gender
Male	63.27	50	60	0.35
Female	36.73	50	40
Age groups
> 55	24.49	5	15	0.12
35-55	62.24	77.5	70
< 35	13.27	17.5	15
Monthly income
0-200	32.61	30.77	33.33	0.32
204-670	17.39	25.64	5.56
672-739	21.74	30.77	27.78
743-2650	28.26	12.82	33.33
Educational status
No college	70.59	78.57	72.73	0.73
College	29.41	21.43	27.27
Accommodation
Yes	60.42	72.50	70	0.35
No	39.58	27.50	30
HIV treatment adherence
No	26.53	25	45	0.51
Yes	48.98	52.50	40
Unknown	24.49	22.50	15
Substance abuse
No	41.84	30	45	0.37
Yes	58.16	70	55
Problem drinking
No	72.45	53.85	45	0.02
Yes	27.55	46.15	55

HIV: Human immunodeficiency virus; MDD: Major depressive disorder.

Full article at:   http://goo.gl/7ob6Eo

By:  Amanor-Boadu S1, Hipolito MS1, Rai N1, McLean CK1, Flanagan K1, Hamilton FT1, Oji V1, Lambert SF1, Le HN1, Kapetanovic S1, Nwulia EA1.

1Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States

World J Psychiatry. 2016 Mar 22;6(1):128-35. doi: 10.5498/wjp.v6.i1.128. eCollection 2016.

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The Economic Benefits of High CD4 Counts among People Living with HIV/AIDS in Zambia

BACKGROUND:

The economic effects of poor immunologic recovery among HIV-infected patients receiving antiretroviral therapy (ART) in sub-Saharan Africa are not well understood. We examined the relationship between the CD4 counts of patients on long-term ART and employment outcomes in HIV-affected households in Lusaka, Zambia.

METHODS:

Administrative data and a household survey captured information on the clinical records, demographics and employment outcomes of the ART-treated adults and their adult family members (n = 311). Multivariable regression analyses were used to assess relationships between CD4 counts of ART-treated adults and household employment outcomes.

RESULTS:

Patients with a CD4 count of at least 350 cells/µl were 22 percentage points more likely to be engaged in the labor force (P < 0.05) and worked ∼6 more days per month (P < 0.05) and 9 more hours per week (P = 0.05) compared with patients with a CD4 count <350 cells/µl. Non-patient adults in the HIV-affected household had significantly higher labor participation if the patient's CD4 count was ≥500 compared with <500 cells/µl (P < 0.05), but this was not significant for a CD4 ≥350 versus <350.

CONCLUSION:

These findings suggest that interventions to improve or maintain robust immune recovery during ART may confer economic benefits for both HIV-infected individuals and HIV-affected households.

Purchase full article at:   http://goo.gl/ZshgGL

By:  Tirivayi N1, Koethe JR2.

• 1UNU-MERIT (United Nations University), Maastricht 6211 TC, The Netherlands.
• 2Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA. 
• J Public Health (Oxf). 2016 Jan 19. pii: fdv199.

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About Your Viral Load and CD4

Via:  http://ht.ly/U99rs HT https://twitter.com/CDCgov

Derivation and Validation of an Accurate Estimation of CD4 Counts from the Absolute Lymphocyte Count in Virologically Suppressed and Immunologically Reconstituted HIV Infected Adults

Below:  Accuracy of CD4 estimates as a function of time and stratified by baseline CD4 percent. ‘Overall’ includes all results

Data from 3,630 subjects were available. CD4 counts were generally accurately estimated, with a mean 6.1 % underestimation. Overall 83.3 % of CD4 estimates were within 25 % of the actual values, with 12.1 % CD4 counts underestimated by more than 25 %, and 4.5 % overestimated. The CD4 count was increasingly underestimated with time from baseline, and the degree of underestimation correlated with baseline CD4 percent (p < 0.0001). From the case–control study, baseline CD4 percent of ≥20, no illness requiring hospitalization and more than a year since starting or switch of anti-retroviral therapy were identified as significant predictors of inaccurate estimates. Employing this simple algorithm, CD4 estimate accuracy improved to a mean 1.3 % underestimation, and the proportion of estimates within 25 % of the actual value increased to 93.4 %.

In virologically-suppressed and immune-reconstituted HIV-infected adults, the CD4 count can be accurately estimated from the ALC using a baseline CD4 percent for at least 2 years after measurement.

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