Correlation of CD₄ counts with the fnac patterns of tubercular lymphadenitis in patients with HIV: A cross sectional pilot study

Background: Fine needle aspiration cytology (FNAC) of TB lymphadenitis (TBL) in HIV shows four different patterns, which may be reflective of immune status. We hypothesize that the CD₄ counts, a marker of immunologic status, correlates with FNAC morphology of TBL. This study was undertaken to compare the mean CD₄ counts across the different cytology patterns and to correlate the CD₄ counts with FNAC patterns in these patients. Methods: Forty newly diagnosed HIV patients with TBL on FNAC (10 in each pattern) were selected by convenient sampling based on inclusion exclusion criteria. The CD₄ counts were obtained in these patients. Its correlation with different FNAC patterns was assessed using SPSS version 16. Results: Analysis of covariance showed significant difference in the mean CD₄ counts between all the four patterns [F (374), df (3), Pvalue50.000]. Spearman's correlation analysis showed significant correlation of CD₄ counts with the FNAC patterns (correlation coefficient of 0.967; P-value of 0.01) with pattern 1 having low CD₄ counts and pattern 4 having high CD₄ counts. Conclusion: CD₄ counts show significant correlation with FNAC patterns of TBL in HIV patients. Pattern 1, suggestive of poor immunological response (chiefly necrosis, occasional ill defined granuloma, AFB 31) had low CD₄ counts, while pattern 4, suggestive of good immunological response (well defined granuloma, no necrosis and AFB 11), had high CD₄ counts. Thus FNAC patterns may be used to predict the CD₄ counts in HIV patients where CD₄ facilities are not available or vice versa.