A review on peripheral blood CD4+ T lymphocyte counts in healthy adult Indians

Indian Journal of Medical Research

Volumn 132, Issue 12, 2010, Pages 667-675

  Shete, Ashwini ^a   Thakar, Madhuri ^a   Abraham, Philip Raj ^a   Paranjape, Ramesh ^a  

^a NATIONAL AIDS RESEARCH INSTITUTE   (India)

Author keywords

CD4; HIV; Reference range; T lymphocytes

Indexed keywords

BLOOD; CD4 LYMPHOCYTE COUNT; CD8+ T LYMPHOCYTE; DISEASE COURSE; GEOGRAPHY; GROUPS BY AGE; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; IMMUNOLOGICAL MONITORING; INDIA; INDIAN; NORMAL HUMAN; REFERENCE VALUE; REVIEW; ADULT; CD4+ T LYMPHOCYTE; CHILD; IMMUNOLOGY; STATISTICS;

ADULT; CD4 LYMPHOCYTE COUNT; CD4-POSITIVE T-LYMPHOCYTES; CHILD; HIV INFECTIONS; HUMANS; INDIA; REFERENCE VALUES;

EID: 78751512247     PISSN: 09715916     EISSN: 09715916     Source Type: Journal    
DOI: None     Document Type: Review

References (79)

1. Zhu J, Paul WE. CD4 T cells: fates, functions, and faults. Blood 2008; 112: 1557-69.
2. Mosmann TR, Coffman RL. TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev Immunol 1989; 7: 145-73.
3. Pattanapanyasat K, Thakar MR. CD4+ T cell count as a tool to monitor HIV progression & anti-retroviral therapy. Indian J Med Res 2005; 121: 539-49.
4. [No authors listed]. 1997 revised guidelines for performing CD4+ T-cell determinations in persons infected with human immunodeficiency virus (HIV). Centers for Disease Control and Prevention. MMW Recomm Rep 1997; 46: 1-29.
5. Jain A, Atkinson TP, Lipsky PE, Slater JE, Nelson DL, Strober W. Defects of T-cell effector function and post-thymic maturation in X-linked hyper-IgM syndrome. J Clin Invest 1999; 103: 1151-8.
6. Nicholson JK. Use of flow cytometry in the evaluation and diagnosis of primary and secondary immunodeficiency diseases. Arch Pathol Lab Med 1989; 113: 598-605.
7. Bleesing JJ, Straus SE, Fleisher TA. Autoimmune lymphoproliferative syndrome. A human disorder of abnormal lymphocyte survival. Pediatr Clin North Am 2000; 47: 1291-310.
8. Storek J, Witherspoon RP. Immunologic reconstitution after haematopoietic stem cell transplantation. In: Atkinson K, editor, Clinical bone marrow and blood stem cell transplantation, 2nd ed. Cambridge, United Kingdom: Cambridge University Press; 2000. p. 111-46.
9. Eckschlager T, Prusa R, Hladikova M, Radvanska J, Slaby K, Radvansky J. Lymphocyte subpopulations and immunoglobulin levels in Hodgkin's disease survivors. Neoplasma 2004; 51: 261-4.
10. Eckschlager T, Radvanska J, Slabý K, Prusa R, Hochova I, Radvanský J. Changes of blood count, lymphocyte subpopulations and immunoglobulin levels in nephroblastoma long term survivors. Neoplasma 2009; 56: 9-12.
11. Ducloux D, Carron PL, Motte G, Ab A, Rebibou JM, Bresson-Vautrin C, et al. Lymphocyte subsets and assessment of cancer risk in renal transplant recipients. Transpl Int 2002; 15: 393-6.
12. Fahey JL, Taylor JM, Detels R, Hofmann B, Melmed R, Nishanian P, et al. The prognostic value of cellular and serologic markers in infection with human immunodeficiency virus type 1. N Engl J Med 1990; 322: 166-72.
13. Stein DS, Korvick JA, Vermund SH. CD4+ lymphocyte cell enumeration for prediction of clinical course of human immunodeficiency virus disease: a review. J Infect Dis 1992; 165: 352-63.
14. Lee BW, Yap HK, Chew FT, Quah TC, Prabhakaran K, Chan GS, et al. Age- and sex-related changes in lymphocyte subpopulations of healthy Asian subjects: from birth to adulthood. Cytometry 1996; 26: 8-15.
15. O'Gorman MR, Gelman R. Inter- and intrainstitutional evaluation of automated volumetric capillary cytometry for the quantitation of CD4- and CD8-positive T lymphocytes in the peripheral blood of persons infected with human immunodeficiency virus. Site Investigators and the NIAID New CD4 Technologies Focus Group. Clin Diagn Lab Immunol 1997; 4: 173-9.
16. Maini MK, Gilson RJ, Chavda N, Gill S, Fakoya A, Ross EJ, et al. Reference ranges and sources of variability of CD4 counts in HIV-seronegative women and men. Genitourin Med 1996; 72: 27-31.
17. Miyawaki T, Taga K, Nagaoki T, Seki H, Suzuki Y, Taniguchi N. Circadian changes of T lymphocyte subsets in human peripheral blood. Clin Exp Immunol 1984; 55: 618-22.
18. Nag VL, Agarwal P, Venkatesh V, Rastogi P, Tandon R, Agrawal SK. A pilot study on observations on CD4 & CD8 counts in healthy HIV seronegative individuals. Indian J Med Res 2002; 116: 45-9.
19. Tollerud DJ, Clark JW, Brown LM, Neuland CY, Pankiw-Trost LK, Blattner WA, et al. The influence of age, race, and gender on peripheral blood mononuclear-cell subsets in healthy nonsmokers. J Clin Immunol 1989; 9: 214-22.
20. Uppal SS, Verma S, Dhot PS. Normal values of CD4 and CD8 lymphocyte subsets in healthy indian adults and the effects of sex, age, ethnicity, and smoking. Cytometry B Clin Cytom 2003; 52: 32-6.
21. Gelman R, Cheng SC, Kidd P, Waxdal M, Kagan J. Assessment of the effects of instrumentation, monoclonal antibody, and fluorochrome on flow cytometric immunophenotyping: a report based on 2 years of the NIAID DAIDS flow cytometry quality assessment program. Clin Immunol Immunopathol 1993; 66: 150-62.
22. Giorgi JV, Cheng HL, Margolick JB, Bauer KD, Ferbas J, Waxdal M, et al. Quality control in the flow cytometric measurement of T-lymphocyte subsets: the multicenter AIDS cohort study experience. The Multicenter AIDS Cohort Study Group. Clin Immunol Immunopathol 1990; 55: 173-86.
23. Gratama JW, Kraan J, Van den Beemd R, Hooibrink B, Van Bockstaele DR, Hooijkaas H. Analysis of variation in results of flow cytometric lymphocyte immunophenotyping in a multicenter study. Cytometry 1997; 30: 166-77.
24. Homburger HA, Rosenstock W, Paxton H, Paton ML, Landay AL. Assessment of interlaboratory variability of immunophenotyping. Results of the College of American Pathologists Flow Cytometry Survey. Ann N Y Acad Sci 1993; 677: 43-9.
25. Parker JW, Adelsberg B, Azen SP, Boone D, Fletcher MA, Gjerset GF, et al. Leukocyte immunophenotyping by flow cytometry in a multisite study: standardization, quality control, and normal values in the Transfusion Safety Study. The Transfusion Safety Study Group. Clin Immunol Immunopathol 1990; 55: 187-220.
26. Gratama JW, Kraan J, Keeney M, Granger V, Barnett D. Reduction of variation in T-cell subset enumeration among 55 laboratories using single-platform, three or four-color flow cytometry based on CD45 and SSC-based gating of lymphocytes. Cytometry 2002; 50: 92-101.
27. World Health Organization, Regional Office for South East Asia, New Delhi. Laboratory guidelines for enumerating for CD4T cell lymphocytes in the context of HIV/AIDS. Available from: http://www.searo.who.int/LinkFiles/BCT_HLM-392.pdf, accessed on November 10, 2010.
28. Mandy FF, Nicholson Janet KA, McDougal Steven J. Guidelines for performing single-platform absolute CD4+ T-cell determinations with CD45 gating for persons infected with human immunodeficiency virus. Morb Mortal Wkly Rep, Centers for Disease Control and Prevention, January 31, 2003/52(RR02); 1-13.
29. Malone JL, Simms TE, Gray GC, Wagner KF, Burge JR, Burke DS. Sources of variability in repeated T-helper lymphocyte counts from human immunodeficiency virus type 1-infected patients: total lymphocyte count fluctuations and diurnal cycle are important. J Acquir Immune Defic Syndr 1990; 3: 144-51.
30. Carmichael KF, Abayomi A. Analysis of diurnal variation of lymphocyte subsets in healthy subjects in the Caribbean, and its implication in HIV monitoring and treatment. Afr J Med Med Sci 2006; 35: 53-7.
31. Mientjes GH, van Ameijden EJ, Roos MT, de Leeuw NA, van den Hoek JA, Coutinho RA, et al. Large diurnal variation in CD4 cell count and T-cell function among drug users: implications for clinical practice and epidemiological studies. AIDS 1992; 6: 1269-72.
32. Campbell PJ, Aurelius S, Blowes G, Harvey D. Decrease in CD4 lymphocyte counts with rest; implications for the monitoring of HIV infection. Int J STD AIDS 1997; 8: 423-6.
33. Hulgan T, Shepherd BE, Raffanti SP, Fusco JS, Beckerman R, Barkanic G, et al. Absolute count and percentage of CD4+ lymphocytes are independent predictors of disease progression in HIV-infected persons initiating highly active antiretroviral therapy. J Infect Dis 2007; 195: 425-31.
34. Moore DM, Hogg RS, Yip B, Craib K, Wood E, Montaner JS. CD4 percentage is an independent predictor of survival in patients starting antiretroviral therapy with absolute CD4 cell counts between 200 and 350 cells/microL. HIV Med 2006; 7: 383-8.
35. Gallant JE, Hoffmann, C. CD4 cell count. Available from: http://www.hopkins-hivguide.org/management/laboratory_testing/cd4_cell_count.html2009, accessed on November 10, 2010.
36. Dayama A, Pandit D, Mudaliar S, Bharadwaj R, Bharucha KE, Shrotri AN, et al. A pilot study on CD4 & CD8 cell counts in healthy HIV seronegative pregnant women. Indian J Med Res 2003; 117: 198-200.
37. Kotylo PK, Fineberg NS, Freeman KS, Redmond NL, Charland C. Reference ranges for lymphocyte subsets in pediatric patients. Am J Clin Pathol 1993; 100: 111-5.
38. Embree J, Bwayo J, Nagelkerke N, Njenga S, Nyange P, Ndinya-Achola J, et al. Lymphocyte subsets in human immunodeficiency virus type 1-infected and uninfected children in Nairobi. Pediatr Infect Dis J 2001; 20: 397-403.
39. Ikinciogullari A, Kendirli T, Dogu F, Egin Y, Reisli I, Cin S, et al. Peripheral blood lymphocyte subsets in healthy Turkish children. Turk J Pediatr 2004; 46: 125-30.
40. Lugada ES, Mermin J, Kaharuza F, Ulvestad E, Were W, Langeland N, et al. Population-based hematologic and immunologic reference values for a healthy Ugandan population. Clin Diagn Lab Immunol 2004; 11: 29-34.
41. Kiepiela P, Coovadia HM, Coward P, Woodhead R, Abdool-Karim SS, Becker P. Age-related lymphocyte sub-population changes among healthy Africans from birth to adulthood. Ann Trop Paediatr 1989; 9: 199-205.
42. Tugume SB, Piwowar EM, Lutalo T, Mugyenyi PN, Grant RM, Mangeni FW, et al. Hematological reference ranges among healthy Ugandans. Clin Diagn Lab Immunol 1995; 2: 233-5.
43. Lin SC, Chou CC, Tsai MJ, Wu KH, Huang MT, Wang LH, et al. Age-related changes in blood lymphocyte subsets of Chinese children. Pediatr Allergy Immunol 1998; 9: 215-20.
44. O'Gorman MR, Zijenah LS. CD4 T cell measurements in the management of antiretroviral therapy - A review with an emphasis on pediatric HIV-infected patients. Cytometry B Clin Cytom 2008; 74 (Suppl 1): S19-S26.
45. Shahabuddin S, al Ayed IH, el-Rad MO, Qureshi MI. Lymphocyte subset reference ranges in healthy Saudi Arabian children. Pediatr Allergy Immunol 1998; 9: 44-8.
46. Swaminathan S, Hanna LE, Raja A, Sankaran K, Kumar AN. Age-related changes in blood lymphocyte subsets of south Indian children. Natl Med J India 2003; 16: 249-52.
47. Bofill M, Janossy G, Lee CA, MacDonald-Burns D, Phillips AN, Sabin C, et al. Laboratory control values for CD4 and CD8 T lymphocytes. Implications for HIV-1 diagnosis. Clin Exp Immunol 1992; 88: 243-52.
48. Reichert T, DeBruyere M, Deneys V, Totterman T, Lydyard P, Yuksel F, et al. Lymphocyte subset reference ranges in adult Caucasians. Clin Immunol Immunopathol 1991; 60: 190-208.
49. Royce RA, Winkelstein W, Jr. HIV infection, cigarette smoking and CD4+ T-lymphocyte counts: preliminary results from the San Francisco Men's Health Study. AIDS 1990; 4: 327-33.
50. Vithayasai V, Sirisanthana T, Sakonwasun C, Suvanpiyasiri C. Flow cytometric analysis of T-lymphocytes subsets in adult Thais. Asian Pac J Allergy Immunol 1997; 15: 141-6.
51. Kalinkovich A, Weisman Z, Burstein R, Bentwich Z. Standard values of T-lymphocyte subsets in Africa. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 17: 183-5.
52. Jiang W, Kang L, Lu HZ, Pan X, Lin Q, Pan Q, et al. Normal values for CD4 and CD8 lymphocyte subsets in healthy Chinese adults from Shanghai. Clin Diagn Lab Immunol 2004; 11: 811-3.
53. Al Qouzi A, Al Salamah A, Al Rasheed R, Al Musalam A, Al Khairy K, Kheir O, et al. Immunophenotyping of peripheral blood lymphocytes in Saudi men. Clin Diagn Lab Immunol 2002; 9: 279-81.
54. Chng WJ, Tan GB, Kuperan P. Establishment of adult peripheral blood lymphocyte subset reference range for an Asian population by single-platform flow cytometry: influence of age, sex, and race and comparison with other published studies. Clin Diagn Lab Immunol 2004; 11: 168-73.
55. Kam KM, Leung WL, Kwok MY, Hung MY, Lee SS, Mak WP. Lymphocyte subpopulation reference ranges for monitoring human immunodeficiency virus-infected Chinese adults. Clin Diagn Lab Immunol 1996; 3: 326-30.
56. Aina O, Dadik J, Charurat M, Amangaman P, Gurumdi S, Mang E, et al. Reference values of CD4 T lymphocytes in human immunodeficiency virus-negative adult Nigerians. Clin Diagn Lab Immunol 2005; 12: 525-30.
57. Yaman A, Cetiner S, Kibar F, Tasova Y, Seydaoglu G, Dundar IH. Reference ranges of lymphocyte subsets of healthy adults in Turkey. Med Princ Pract 2005; 14: 189-93.
58. Tsegaye A, Messele T, Tilahun T, Hailu E, Sahlu T, Doorly R, et al. Immunohematological reference ranges for adult Ethiopians. Clin Diagn Lab Immunol 1999; 6: 410-4.
59. Ngowi BJ, Mfinanga SG, Bruun JN, Morkve O. Immunohaematological reference values in human immunodeficiency virus-negative adolescent and adults in rural northern Tanzania. BMC Infect Dis 2009; 9: 1.
60. Bussmann H, Wester CW, Masupu KV, Peter T, Gaolekwe SM, Kim S, et al. Low CD4+ T-lymphocyte values in human immunodeficiency virus-negative adults in Botswana. Clin Diagn Lab Immunol 2004; 11: 930-5.
61. Saxena RK, Choudhry V, Nath I, Das SN, Paranjape RS, Babu G, et al. Normal ranges of some select lymphocyte subpopulations in peripheral blood of normal healthy Indians. Curr Sci 2004; 86: 969-75.
62. Kannangai R, Prakash KJ, Ramalingam S, Abraham OC, Mathews KP, Jesudason MV, et al. Peripheral CD4+/CD8+ T-lymphocyte counts estimated by an immunocapture method in the normal healthy south Indian adults and HIV seropositive individuals. J Clin Virol 2000; 17: 101-8.
63. Murugavel KG, Balakrishnan P, Mohanakrishnan J, Solomon SS, Shankar EM, Muthu Sundaram SP, et al. Establishment of T-lymphocyte subset reference intervals in a healthy adult population in Chennai, India. Indian J Med Res 2009; 129: 59-63.
64. Amatya R, Vajpayee M, Kaushik S, Kanswal S, Pandey RM, Seth P. Lymphocyte immunophenotype reference ranges in healthy Indian adults: implications for management of HIV/AIDS in India. Clin Immunol 2004; 112: 290-5.
65. Ray K, Gupta SM, Bala M, Muralidhar S, Kumar J. CD4/CD8 lymphocyte counts in healthy, HIV-positive individuals & AIDS patients. Indian J Med Res 2006; 124: 319-30.
66. Attili VS, Sundar S, Singh VP, Rai M. Validity of existing CD4+ classification in north Indians, in predicting immune status. J Infect 2005; 51: 41-6.
67. Ramalingam S, Kannangai R, Zachariah A, Mathai D, Abraham C. CD4 counts of normal and HIV-infected south Indian adults: do we need a new staging system? Natl Med J India 2001; 14: 335-9.
68. Shahapur PR, Bairy I, Shivananda PG. CD4 and CD8 reference counts in normal healthy south-Indian adults. Indian J Med Microbiol 2008; 26: 280-1.
69. Das BR, Bhanushali AA, Khadapkar R, Jeswani KD, Bhavsar M, Dasgupta A. Reference ranges for lymphocyte subsets in adults from western India: Influence of sex, age and method of enumeration. Indian J Med Sci 2008; 62: 397-406.
70. Singh YG, Dar L, Singh NG. Levels of CD4 and CD8 among the inhabitants of Manipur, India. J Commun Dis 2000; 32: 201-6.
71. Singh HR, Singh NG, Singh TB. Estimation of CD4+ and CD8+ T-lymphocytes in human immunodeficiency virus infection and acquired immunodeficiency syndrome patients in Manipur. Indian J Med Microbiol 2007; 25: 126-32.
72. Lifson JD, Finch SL, Sasaki DT, Engleman EG. Variables affecting T-lymphocyte subsets in a volunteer blood donor population. Clin Immunol Immunopathol 1985; 36: 151-60.
73. Rungta A, Hooja S, Vyas N, Rishi S, Rao A, Gupta S. Enumeration of CD4 and CD8 T lymphocytes in healthy HIV seronegative adults of northwest India: a preliminary study. Indian J Pathol Microbiol 2008; 51: 127-9.
74. Branch S, Broome H, Abayomi A. Characteristics of lymphocyte subsets in a normal Afro-Caribbean population and the implications in HIV management. Afr J Med Sci 2006; 35 (Suppl): 109-12.
75. Hammer SM, Saag MS, Schechter M, Montaner Julio SG, Schooley RT, Jacobse DM, et al. Treatment for adult HIV infection: 2006 Recommendations of the International AIDS Society-USA Panel. JAMA 2006; 296: 827-43.
76. Kannangai R, Kandathil AJ, Ebenezer DL, Nithyanandam G, Samuel P, Abraham OC, et al. Evidence for lower CD4+ T cell and higher viral load in asymptomatic HIV-1 infected individuals of India: implications for therapy initiation. Indian J Med Microbiol 2008; 26: 217-21.
77. Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med 2009; 360: 1815-26.
78. Ghate MV, Mehendale SM, Mahajan BA, Yadav R, Brahme RG, Divekar AD, et al. Relationship between clinical conditions and CD4 counts in HIV-infected persons in Pune, Maharashtra, India. Natl Med J India 2000; 13: 183-7.
79. Kumarasamy N, Solomon S, Flanigan TP, Hemalatha R, Thyagarajan SP, Mayer KH. Natural history of human immunodeficiency virus disease in southern India. Clin Infect Dis 2003; 36: 79-85.