Evidence for lower CD4⁺ T cell and higher viral load in asymptomatic HIV-1 infected individuals of India: Implications for therapy initiation

Purpose: We have earlier documented that the south Indian population had lower CD4 counts. The aim of this study was to investigate a previous suggestion on a new CD4⁺ T cell cut off and association with HIV-1 RNA levels for decision on anti retroviral therapy in India (south). Methods: We evaluated a new methodology i.e., artus real-time PCR and CD4⁺ T cell count by Guava EasyCD4™ system. From 146 HIV infected individuals seen at a tertiary care centre, blood was collected for CD4⁺ T cell and HIV-1 RNA estimation. Results: The receiver operating characteristic curve cut off value for the CD4 counts to distinguish between CDC clinical categories A and B was 243 cells/μL, and to distinguish B and C was 153 cells/μL. The RNA level that differentiated CDC A and B was 327473 RNA copies/mL, while for CDC B and C was 688543 copies/mL. There was a significant negative correlation (r = -0.55, P < 0.01) between the RNA estimated and CD4⁺ T cell counts in HIV infected individuals. Conclusions: A majority with CD4 counts of 201-350 cells/μL in our population had higher viral load than the treatment threshold suggested by the International AIDS society and the above two methodologies are useful in monitoring HIV infections.