Author(s): Shravan Kumar Mishra1 , Lilee Shrestha 1 , Roshan Pandit1 , Sundar Khadka 1 , Bimal Shrestha1 , Subhash Dhital1 , Saroj Sharma3 , Mukunda Sharma1 , Raj Kumar Mahato1 , Geeta Shakya1 and Krishna Das Manandhar2
CD4 subset is the T lymphocyte sub-population that is commonly used in clinical arena for decision making of various conditions . It is most widely used blood parameters to monitor human immunodeficiency virus (HIV) patients for disease progression, clinical staging, epidemiological studies, and prophylaxis of some opportunistic infection . CD4 subset tends to decreases with disease progression, leading to relative increase of CD8 T lymphocyte and subsequent reversal of CD4 to CD8 T lymphocyte ratio . The course of disease is better understood by comparing CD4 count with the available local reference range.
HIV RNA viral load testing is considered gold standard to monitor antiretroviral therapy (ART) response. Despite its high sensitivity, viral load testing has a number of problems in use and, is not feasible in all the settings due to high cost and technical demands . In such scenario, CD4 T cell count, and clinical monitoring is recommended to monitor the efficacy of antiretroviral therapy, especially in resource-poor settings . In addition, CD4 count may also be used in decision making for initiation of ART in HIV patients . National HIV testing and treatment guideline in Nepal suggests CD4 count as one of the baseline test to monitor antiretroviral therapy that has to be checked every 6 months. The further steps on prophylaxis could be taken based on CD4 level along with some other baseline test such as Hemoglobin estimation, Urea and Alanine Aminotransferase . These all show that CD4 count is necessary to guide antiretroviral therapy and, to decrease the chance for morbidity, mortality and vertical transmission of the disease .
CD4 count testing service was available at eighteen sites across the country till 2014, which reached to thirty by 2017 . HIV RNA viral load testing was provided only from three centers: National Public Health Laboratory in Kathmandu, Bir Hospital in Kathmandu and Seti Zonal Hospital in Kailali to supplement the ART management program till 2017 . As Nepal is a developing country with weak economic status, it is difficult to establish viral load testing in all the sites. In such case, management of ART program through CD4 count would be effective in achieving the goal to control the progression of HIV in Nepal.
In the past decade, a number of studies have sought to determine the reference range of CD4 and CD3 count in different parts of the world . The variation in reference range due to climatic factors, geographical locations, dietary habits, ethnic variation and environmental factors in different studies has already been documented [11-13]. Nepal is a country with wide geographical, climatic and ethnic variation. A study carried out in Eastern, Central and Western Development region of Nepal showed different mean values for CD4 count . Because Nepal has a wide ethnic and climatic...