Department of Medical Physics, Royal Perth Hospital, Western Australia, 6001,
Valendar F Turner, John Papadimitriou, Barry Page, David Causer, Helman Alfonso, Sam Mhlongo, Todd Miller, Christian Fiala
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More on CD4s
In his rapid response: "Re: Causes of low CD4 counts in AIDS – a question to the Perth Group", 14 September, Peter Flegg wrote: "I was interested to read the Perth Group's assertion that "A person can get CD4 counts of less than 50 per microliter and immune suppression by repeated exposure to: drugs, (1 2) semen, (3-6) Factor 8, (7-9) and malnutrition.(10) (Sept 14). I would also be fascinated to know how many of these articles actually do say the persons in question get CD4 counts of less than 50/mcl, and if they do in what percentage it has occurred. Would the Perth Group be so kind as to oblige by accurately quoting the relevant sentence from each of the studies in question? I only ask because I have no immediate access to the relevant articles in full text version, only in abstract form. Unfortunately in these I can find little to indicate that CD4 lymphopenia occurs to the profoundly low level of under 50/mcl in anybody. Some of the studies are not even in humans, or appear to discuss other immunosuppressive effects such as impaired CTL responses, reduced numbers of PBMCs and so on. The nearest I can get is the finding that four of 229 drug users met the criteria for idiopathic CD4 lymphopenia, (which is defined as having a CD4 count less than 300/mcl)."
The fact is that there is nothing magic about 50 CD4 counts per microliter. Counts of less than 50 per microliter can be found in HIV negative patients.1 Because at the Medical Intensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia "…clinicians use CD4+ cell counts as a surrogate for HIV testing and may make clinically important decisions based on the results", Aldrich et al determined the CD4 counts in 53 "HIV" negative patients admitted in the Intensive Care Unit. They reported that "more than half of the study subjects had absolute CD4+ cell counts on entry that were below the normal range, and in 9 (17%) they were below 0.200 x 109/L. The lowest CD4+ cell count was 0.037 x 109/L.2 These data are in agreement with a study by Fantin et al,3 in which 17.6% of HIV-negative patients with acute pneumonia had CD4+ cell counts below 0.200 x 109/L". If something decreases the CD4 counts to "less than 300/mcl", there is no reason why it should not decrease then to 50 per microliter. As a physician, Peter Flegg is fully aware that if a drug, X, causes an effect, Y, then the magnitude of Y will depend on the dose, the frequency and the duration to which the patient is exposed to X.
Lately, in a few of our rapid responses including the 14 September, we have drawn the attention to the fact, which Peter Flegg chose to ignore, that the "discoverers" of "HIV" themselves have shown that "HIV" is not sufficient or necessary for the decrease in T4 cells either in vitro or in vivo. Once again, in their experiments they have shown that:
(1) "HIV" + stimulation = decrease in T4 cells.
(2) Stimulation by itself = decrease in T4 cells.
(3) HIV" by itself = no effect.4 5
Peter Flegg either:
(1) Disagrees with Gallo's and Montagnier's experimental findings, in which case he must tell them, and thus us, what is wrong with them; or (2) Agrees with Gallo's and Montagnier's findings, in which case he, like us, comes up with an alternative reason for the T4 cell decrease in AIDS patients.
For example, would Peter Flegg please let us know what he tells his haemophiliac patients is the cause for their decreased T4 cell counts?
1. Tassinari P, Deibis L, Bianco N, Echeverria de Perez G. Lymphocyte subset diversity in idiopathic CD4+ T lymphocytopenia. Clin Diagn Lab Immunol 1996;3:611-3.
2. Aldrich J, Gross R, Adler M, King K, MacGregor RR, Gluckman SJ. The effect of acute severe illness on CD4+ lymphocyte counts in nonimmunocompromised patients. Arch Int Med 2000;160:715-6.
3. Fantin B, Joly V, Elbim C, Golmard JL, Gougerot-Pocidalo MA, Yeni P, et al. Lymphocyte subset counts during the course of community-acquired pneumonia: evolution according to age, human immunodeficiency virus status, and etiologic microorganisms. Clin Infect Dis 1996;22:1096-8.
4. Laurent-Crawford AG, Krust B, Muller S, Rivière Y, Rey-Cuillé M-A, Béhet J-M, et al. The Cytopathic Effect of HIV is Associated with Apoptosis. Virol 1991;185:829-839.
5. Zagury D, Bernard J, Leonard R, Cheynier R, Feldman M, Sarin PS, et al. Long-Term Cultures of HTLV-III-Infected T Cells: A Model of Cytopathology of T-Cell Depletion in AIDS. Science 1986;231:850-853.
Competing interests: None declared