CD4+ T-LYMPHOCYTOPENIA IN SEVERE PULMONARY TUBERCULOSIS WITHOUT EVIDENCE OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION

The majority of pulmonary tuberculosis (PT) patients admitted to the Phthisiopulmonology Division of "Dr. Enrique Tornu" Hospital in Buenos Aires are tested for HIV. Blood CD4 and CD8 T-lymphocytes are also measured in all HIV-positive and some HIV-negative patients. Noting that some HIV-negative PT patients of generally compromised health status had low CD4 T-lymphocyte counts the authors decided to study a group of tuberculosis (TB) patients in relation to their initial general conditions weights and CD4 and CD8 T-lymphocyte values in blood. 17 HIV-negative patients with severe pulmonary TB (SPT) of mean age 44.1 years had on admission lost 20% or more of their normal weight. The control group was comprised of 10 male HIV-negative PT patients of mean age 25.2 years and in good general condition. The CD4/CD8 count among SPT patients before treatment was a mean 341.25/cu. mm for CD4 and 259.33/cu. mm for CD8. The 3 patients who died a few weeks after beginning treatment had 180 220 and 280 CD4/cu. mm respectively upon admission. In contrast the patients in good general condition had a CD4 level of 721.40/cu. mm and CD8 of 416.67/cu. mm. 5 normal volunteers of mean age 35.60 years had mean CD4 and CD8 counts of 906 and 360 respectively. CD4 and CD8 T-lymphocyte counts should be measured in SPT patients with a compromised general condition and with significant weight loss at the beginning of treatment. Patients with a CD4 count lower than 300/cu. mm have a very poor prognosis and will need intensive care during the first weeks of treatment above and beyond the regular antituberculosis drugs.