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• W2087093670 abstract "In their Authors' reply (Jan 10, p 165),1Mwaba P Cassol S Nunn AJ Chintu C Zumla A Dried blood spot technology for CD4+ T-cell cell counting.Lancet. 2004; 363: 164-165Summary Full Text Full Text PDF Scopus (16) Google Scholar Peter Mwaba and colleagues do not discuss the fact that they did not publish the CD4+ counts below 200 cells per μL, nor respond to the request by Howard Shapiro and colleagues2Shapiro HM Mandy F Rinke de Wit TF Sandstrom P Dried blood spot technology for CD4+ T-cell counting.Lancet. 2004; 363: 164Summary Full Text Full Text PDF PubMed Google Scholar to address the issue of the imprecision of their CD4+ cell-counting technique at values above this concentration. Additionally, Shapiro's point about measuring CD4 molecules that derive from monocytes is regarded by Mwaba and colleagues as of mere “academic” interest, but this is a crucial practical issue. In western countries, the numbers of released CD4 molecules detected by ELISA methods such as TRAx3Paxton H Pins M Denton G et al.Comparison of CD4 cell count by a simple enzyme-linked immunosorbent assay using the TRAx CD4 test kit and by flow cytometry and hematology.Clin Diagn Lab Immunol. 1995; 2: 104-114PubMed Google Scholar show good correlation with CD4+ T-cell counts, but in about 20% of cases in resource-poor tropical countries, this method results in aberrantly high CD4 ELISA values.4Loua A Kestens L Vanham G et al.Validity of an ELISA test for CD4+ Tlymphocyte count and validity of total lymphocyte count in the assessment of immunodeficiency status in HIV infection.Ann Soc Belg Med Trop. 1994; 74: 61-68PubMed Google Scholar The detected phantom lymphocytes must be non-T-cells because values as high as 250–400 CD4+ cells per μL have been seen in samples with cytometry-proven CD4+ T-cell counts of 50–100 cells per μL. In tropical countries, monocytes, which in addition to T lymphocytes are also positive for the CD4 antigen,5Janossy G Jani IV Brando B New trends in affordable CD4+ T-cell enumeration by flow cytometry in HIV/AIDS.Clin Appl Immunol Rev. 2003; 4: 93-110Crossref Scopus (17) Google Scholar can be activated by Mycobacterium tuberculosis or parasites. ELISAs such as TRAx or dried blood-spot methods also detect monocyte-derived CD4 molecules, thus providing misleadingly high and clinically dangerous readings for CD4+ T-cell counts, particularly in patients with tuberculosis. Similarly, the problem with measuring soluble CD4 below 200 CD4 per μL is not so much an issue of sensitivity but that of monocyte interference. In patients with severe CD4 lymphopenia, the CD4 molecules deriving from monocytes, which are normally hidden in the background counts of the ELISA test,3Paxton H Pins M Denton G et al.Comparison of CD4 cell count by a simple enzyme-linked immunosorbent assay using the TRAx CD4 test kit and by flow cytometry and hematology.Clin Diagn Lab Immunol. 1995; 2: 104-114PubMed Google Scholar can regularly manifest themselves. Finally, the dried blood-spot test, unlike a dipstick test, is not assessed on site, but samples are sent to a laboratory. This arrangement is not different from taking blood into tubes containing stabilising fluids and transporting them to regional laboratories for flow cytometry. Mwaba and colleagues are exploring the resurrection of a flawed design that would offer an inferior testing option and the danger of clinical misinterpretation. As Mwaba and colleagues say, we should all focus on developing not-for-profit, simple, low-tech, quality assured methods for improved management of HIV-infected patients. However, the lack of evidence presented to support dried blood-spot technology and the achievements of the new CD4 counting methods5Janossy G Jani IV Brando B New trends in affordable CD4+ T-cell enumeration by flow cytometry in HIV/AIDS.Clin Appl Immunol Rev. 2003; 4: 93-110Crossref Scopus (17) Google Scholar suggest that progress is more likely to come from flow cytometry and analytical image systems that properly discriminate between lymphocytes and monocytes.2Shapiro HM Mandy F Rinke de Wit TF Sandstrom P Dried blood spot technology for CD4+ T-cell counting.Lancet. 2004; 363: 164Summary Full Text Full Text PDF PubMed Google Scholar, 5Janossy G Jani IV Brando B New trends in affordable CD4+ T-cell enumeration by flow cytometry in HIV/AIDS.Clin Appl Immunol Rev. 2003; 4: 93-110Crossref Scopus (17) Google Scholar I thank Luc Kestens (Institute of Tropical Medicine, Antwerp, Belgium), Frank Mandy (Health Canada, Ottawa), and members of the AffordCD4 team (http://www.AffordCD4.com) for discussions. Dried blood spot technology for CD4+ T-cell countingAuthors' reply Full-Text PDF" @default.
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• W2087093670 title "Dried blood spot technology for CD4+ T-cell counting" @default.
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