Lymphnode cytopathology and CD4 count in HIV positive patients

Introduction: CD4 is an important prognostic as well as therapeutic marker in the management of HIV and this study identifies the correlation between CD4 counts and FNAC lymphnode (LN) patterns in these patients. Study Design: The study was conducted in the rural areas at Nalgonda district by Kamineni Institute of Medical Sciences, Telangana. Eventhough Fine Needle Aspiration Cytology (FNAC) was done on total 56 selected patients who had lymphadenopathy and were tested HIV positive, only 50 of them have CD4 counts and were selected as final study group. Suspected cytosmears have acid fast staining done by Ziehl Nelson technique. The final cytopathological findings were correlated with CD4 counts. Results: In our study, high CD4 counts were associated with reactive lymphadenitis (26%;13/50) most and Low CD4 counts were associated with less frequent suppurative lymphadenitis and particulary TB lymphadenitis was noticed in 56% (28/50) and morphologically exhibited 4 different patterns– caseous with epitheloid granuloma, only caseous necrosis, only epitheloid granuloma and suppurative. Conclusion: CD4 count correlated well with the different stages of immunosuppression in HIV patients. The patients with reactive lymphadenitis demonstrated high CD4 counts suggesting good immunological response. The low CD4 counts seen in patients with suppurative lymphadenitis and cryptococcal infection suggests severe immuno-compromised state.