REVIEW OF LOW CD4 COUNT AND IMPLICATIONS IN HIV
Since the mid 1990’s, highly active retroviral therapy (HAART) has significantly and radically modified AIDS prognosis by suppressing viral replication and consequently allowing immune restoration1,2. Central to this innovative therapeutic approach to national guidelines in most resource-rich settings and part of the WHO 2013 consolidated guidelines is the monitoring of viral load (VL). However, in low- and middle- income countries with limited resources and restricted access to more costly second and third-line drugs, the utility of viral load monitoring is under heated debate3. In resource-constrained settings CD4+ T-lymphocyte counts have been regularly relied upon to make treatment decisions such as when to start antiretroviral medications and when to begin preventive antibiotics4, 5 .
Macrophages and CD4+ T-cells have been shown to be important targets of HIV and the role they play in the body’s specific immune response is one mechanism by which the virus inflicts devastation on the host 6 leading to the consideration of low CD4+ T-lymphocyte counts to be a marker of the progression of HIV infection and AIDS, and have been called the signature of HIV7.
Recently emerging research has however cast doubts on the validity of using CD4+ T-cell counts in the diagnosis of AIDS and in making important clinical decisions for disease management. Low CD4 counts have been recently shown to be associated with a variety of conditions including many viral infections, tuberculosis, psychological stress and social isolation8.
Feeney et al. reported low CD4 counts in a study that looked at CD4 counts in 102 consecutive intensive care unit HIV negative patients suffering from 34 different illnesses with the most common being myocardial infarction( heart attack), severe bleeding, renal failure, trauma, and chronic pulmonary