Journal of Clinical Immunology

, Volume 25, Issue 2, pp 127-133

First online:

Determinants of CD4 Counts Among HIV-Negative Ethiopians: Role of Body Mass Index, Gender, Cigarette Smoking, Khat (Catha Edulis) Chewing, and Possibly Altitude?

  • C. AbuyeAffiliated withDepartment of Nutrition, Ethiopian Health and Nutrition Research Institute (EHNRI)
  • , A. TsegayeAffiliated withEthio–Netherlands AIDS Research Project (ENARP), EHNRI
  • , C. E. WestAffiliated withDivision of Human Nutrition and Epidemiology, Wageningen University
  • , P. VerslootAffiliated withDivision of Human Nutrition and Epidemiology, Wageningen University
  • , E. J. SandersAffiliated withEthio–Netherlands AIDS Research Project (ENARP), EHNRI
  • , D. WoldayAffiliated withEthio–Netherlands AIDS Research Project (ENARP), EHNRI
  • , D. HamannAffiliated withDepartment of Clinical Viro-Immunology. CLB and the Laboratory of Experimental and Clinical Immunology, Academic Medical Centre, University of Amsterdam
  • , T. F. Rinke De WitAffiliated withEthio–Netherlands AIDS Research Project (ENARP), EHNRI
  • , A. L. FontanetAffiliated withDivision of Public Health and Environment, Municipal Health ServiceEmerging Diseases Epidemiology Unit, Pasteur InstituteEmerging Diseases Epidemiology Unit, Pasteur Institute Email author 

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To study the determinants of CD4% and CD4 counts among HIV-negative Ethiopians, and to identify factors susceptible to explain the low CD4 counts observed among Ethiopian subjects. Cohort studies among factory workers in Akaki and Wonji, Ethiopia. Clinical and laboratory examinations, including determination of HIV serological status and T-cell subsets, were performed during follow-up visits every six months. In addition, micronutrients (retinol, carotenoids, tocopherol, transferrin receptor, and selenium) plasma concentrations were determined in a subset of 38 HIV-positive and 121 HIV-negative participants. HIV-negative participants with at least one CD4 count measurement were 157 females in Akaki, 203 males in Akaki, and 712 males in Wonji. CD4 counts were independently and positively associated with body mass index (through an increase in lymphocyte counts), female gender (through an increase in CD4%), cigarette smoking (through an increase in CD4%), khat chewing (through an increase in both lymphocyte counts and CD4%), and Akaki study site (through a large increase in lymphocyte counts compensating a decrease in CD4%). Intestinal parasitic infections were not associated with CD4% or CD4 counts. Retinol, carotenoids, and α-tocopherol plasma concentrations decreased with HIV infection and advancing immunosuppression, but were not associated with CD4 counts among HIV-negative subjects. Low body mass index among Ethiopians may have contributed to their overall low CD4 counts. Other factors remain to be elucidated.


CD4 counts micronutrients BMI altitude Ethiopia