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ORIGINAL ARTICLE
Year : 2013  |  Volume : 17  |  Issue : 6  |  Page : 1012-1017

CD4 count as a predictor of adrenocortical insufficiency in persons with human immunodeficiency virus infection: How useful?


1 Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Surulere, Nigeria
2 Department of Chemical Pathology, General Hospital, Lagos, Nigeria

Correspondence Address:
Ifedayo A Odeniyi
Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Surulere, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.122615

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Objective: To determine the usefulness of CD4 count in predicting adrenocortical insufficiency (AI) in persons with HIV infection. Design: Experimental study involving people with HIV infection and healthy people. Participants: The participants were recruited from the Lagos University Teaching Hospital. Forty-three newly diagnosed, treatment naive persons with HIV (23 males and 20 females) and 70 (35 males and 35 females) HIV negative subjects completed the study. Intervention: One microgram Synacthen® was given intravenously to stimulate the adrenal glands. Main Outcome Measures: Blood was collected for cortisol at 0 and 30 min after the injection of adrenocorticotropic hormone (ACTH) and CD4 count. Results: Mean basal cortisol was 154.9 ± 27.2 nmol/L and 239.9 ± 31.6 nmol/L (P < 0.001); the 30-min post ACTH test, cortisol level was 354.8 ± 19.9 nmol/L and 870.9 ± 163.5 nmol/L (P < 0.001); the increment was 100.0 ± 17.2 nmol/L and 588.8 ± 143.4 nmol/L (P < 0.001) in HIV and healthy subject group; respectively. Using the diagnostic criteria for diagnosis of AI in this study, fifteen (34.8%) persons with HIV had AI. There was no significant correlation between basal cortisol levels and CD4 count in patients with HIV infection (r = -0.2, P = 0.198). There was no significant correlation between stimulated cortisol level and CD4 count in patients with HIV infection (r = -0.09, P = 0.516). Conclusion: CD4 count does not predict the presence or absence of AI. ACTH stimulation of the adrenal gland remains the acceptable standard.


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