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Year : 2006  |  Volume : 9  |  Issue : 4  |  Page : 117-123

Determination of maternal immune status of hiv positive women using cd4 count level: Implications for the Nigerian pmtct programme

1 M aterna- fetal Unit, Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria
2 Department of Pathology, University of Benin Teaching Hospital, Benin City, Nigeria

Correspondence Address:
JUE Onakewhor
Materna-fetal Unit, Department of Obstetrics & Gynaecology , University of Benin Teaching Hospital, Benin City
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Source of Support: None, Conflict of Interest: None

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Background: Whenever HIV and AIDS Is diagnosed, the CD4+ T-l ymphocyte (CD4) counts In addition to clinical staging Is used to determine the severity of the disease and immune depression, make treatment decisions, monitor progress or change treatment options especially in resource- poor setting lacking facilities for viral load estimation. Low CD4 cell counts are a marker and "hallmark" of the progression of HIV infection and AIDS. A CD4 cell count ≤ 200 cells!ml In HIV-positive person is Indicative of AIDS (WHO stage1). Aims/Objective: To determine the Immunological status of HIV-positive pregnant women using maternal CD4 count levels and what the implications are for the Nigerian PMTC Program. Methodology: Only 120 (48.9%) HIV- positive pregnant booked women seen during the period afforded the cost of CD4 count and other tests. Another cohort of 10 HIV -negative pregnant women who consented was used as control. Each woman had 5 ml of blood each drawn from the antecubital vein and the sera separated by centrifugation. The CD4 count levels were estimated using the Manual Magnetic Bead Technique. The data were analyzed using the Graphad Instat tm software version 2.05a statistical package; the Fischer's exact test was used to co0 m pare the means and median values of the CD4 count levels of the two groups and association between CD4 count level and HIV-posltive test using Woolf approximation. Results: The CD4 count ranged between 50 and 934 compared with 511 and 920 cells/ , and a mean of 267 ΁ 50.93 vs 731 ΁ 289.20 (p< 0.0001) and a median value of 212 /mL vs 576 cells0/ mL cells/ml (p< 0.0001) respectively for the HIV1- positive and negative women. 32 (48.5%) HIV-posltive women had CD4 count level ≤200 cells/mL. Only 39.4% had CD4 co0unt levels ≥250cell/mL and 9.1% had CD4 count ≥5OOcells!mL Conclusion: Significant proportion of HIV-infected pregnant women Is lmmuno-depressed and qualifies for HAART In pregnancy. The modest goal of a 20 percent reduction in vertical transmission by 2005 set by The United Nations AIDS Summit can only be realised through aggressive approach to HIV management In these women. CD4 count estimation and use of HAART for PMTCT program tertiary and In well endowed secondary hospitals in Nigeria is advocated.

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