What is the role of CD4+ T-cell counts in predicting ocular complications of HIV infection?

Updated: Jun 12, 2019
  • Author: Robert A Copeland, Jr, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

In general, the CD4+ T-lymphocyte count has been used to predict the onset of certain general conditions and ocular infections in patients who are HIV positive. A CD4+ T-cell count below 500/µL is associated with Kaposi sarcoma, lymphoma, and tuberculosis. A CD4+ T-cell count below 250/µL is associated with pneumocystosis and toxoplasmosis. A CD4+ T-cell count less than 100/µL is associated with the following:

  • Retinal or conjunctival microvasculopathy
  • Cytomegalovirus (CMV) retinitis
  • Varicella-zoster virus (VZV) retinitis
  • Mycobacterium avium complex infection
  • Cryptococcosis
  • Microsporidiosis
  • HIV encephalopathy
  • Progressive multifocal leukoencephalopathy

The predictive value of the CD4+ T-cell count for ocular complications in HIV infection has been called into question by reports of CMV retinitis in patients with CD4+ cell counts higher than 200 cells/µL. These patients reportedly were taking highly active antiretroviral therapy (HAART). While such findings may argue against the protective effect of an increased CD4+ cell count, the possibility that the CMV retinitis preceded the recovery of CD4+ cell count was not ruled out. Thus, whether a reconstituted T-cell count will serve as a better predictor of specific ocular infection is under active evaluation.

Despite these uncertainties, the CD4+ cell count has remained the predicting parameter for the occurrence of specific ocular infection in patients who are HIV positive, at least until antigen-specific tests of T-lymphocyte function become widely available.

For other discussions of HIV infection, see HIV Disease, Pediatric HIV Infection, and Antiretroviral Therapy for HIV Infection.

For patient education information, see the Immune System Center and Sexually Transmitted Diseases Center, as well as HIV/AIDS.


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