This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Review for Clinical Practitioners

Barbara J. Turner, MD, MSEd; Frederick M. Hecht, MD; Rokiah B. Ismail, MBBS, MRCP

Arch Intern Med. 1994;154(14):1561-1573.

Abstract
The CD4⁺ lymphocyte is a major target of the human immunodeficiency virus type 1 (HIV-1). CD4⁺ T-lymphocyte measures have been used to predict the risk of HIV-1— related complications in diverse populations, to guide management decisions, and to define cases of the acquired immunodeficiency syndrome (AIDS). To examine the role of CD4⁺ measures in the management and epidemiologic monitoring of HIV-1 infection, we evaluated current literature regarding the accuracy and precision of CD4⁺ measures and the use of these and other prognostic measures in the care of HIV-1—infected persons. Several studies have reported wide intraindividual and interindividual variability in the absolute CD4⁺ count, which can detract from its clinical usefulness. Approaches to address this variability include the following: drawing specimens at a similar time of the day; monitoring CD4⁺ percent that has less variability; following a meticulous laboratory technique; using serial tests to guide management decisions; and retesting after efforts to eliminate transient treatment and clinical factors that can affect the CD4⁺ count. The expense and limited availability of CD4⁺ measures also present barriers to widespread use. Other laboratory and clinical factors offer additional prognostic information and have an evolving role in management decisions. CD4⁺ measures have an important role in HIV-1 clinical care, research, and disease surveillance, but strategies are required to address problems with variability, expense, and availability.

(Arch Intern Med. 1994;154:1561-1573)

Author Affiliations
From the Division of General Internal Medicine and Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pa (Dr Turner); the Division of General Internal Medicine, San Francisco General Hospital and University of California—San Francisco (Dr Hecht); and the Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur (Dr Ismail).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Harnessing the physiology of lymphopenia to support adoptive immunotherapy in lymphoreplete hosts
Cui et al.
Blood 2009;114:3831-3840.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Screening for HIV in the Era of Highly Active Antiretroviral Therapy
Sanders et al.
NEJM 2005;352:570-585.
ABSTRACT | FULL TEXT  

Ocular Manifestations of HIV Infection
Cunningham and Margolis
NEJM 1998;339:236-244.
FULL TEXT  

Selective Causes of Fever in Adult Human Immunodeficiency Virus--Infected Patients Relative to CD4+ Cell Counts
Czachor and Gleckman
Arch Fam Med 1995;4:879-884.
ABSTRACT