Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 331-339 (doi:10.1542/peds.2007-2308)

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Pahwa, S. Search for Related Content PubMed PubMed Citation Articles by Pahwa, S. Related Collections Infectious Disease & Immunity Related AAP Red Book topics: Human Immunodeficiency Virus... Social Bookmarking                         What's this?

ARTICLE

CD4⁺/CD8⁺ T Cell Ratio for Diagnosis of HIV-1 Infection in Infants: Women and Infants Transmission Study

Savita Pahwa, MD^a, Jennifer S. Read, MD^b, Wanrong Yin, MS^c, Yvonne Matthews, MA^c, William Shearer, MD^d, Clemente Diaz, MD^e, Kenneth Rich, MD^f, Hermann Mendez, MD^g, Bruce Thompson, PhD^c for the Women and Infants Transmission Study

^a Departments of Microbiology and Immunology, and Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida
^b Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
^c Clinical Trials & Surveys Corp, Baltimore, Maryland
^d Department of Pediatrics, Baylor College of Medicine, Houston, Texas
^e Department of Pediatrics, University of Puerto Rico, San Juan, Puerto Rico
^f Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
^g Department of Pediatrics, State University of New York, Brooklyn, New York

OBJECTIVE. In this study, we tested the hypothesis that the CD4⁺/CD8⁺ T cell ratio could predict HIV infection status in HIV-exposed infants.

METHODS. CD4⁺/CD8⁺ T cell ratios were determined from data for live-born singleton infants who had been prospectively enrolled in the Women and Infants Transmission Study. Data for 2208 infants with known HIV infection status (179 HIV-infected and 2029 uninfected infants) were analyzed.

RESULTS. Receiver operating characteristic curves indicated that the CD4⁺/CD8⁺ T cell ratio performed better than the proportion of CD4⁺ T cells for diagnosis of HIV infection as early as 2 months of age, and this relationship was unaffected by adjustment for maternal race/ethnicity, infant birth weight, gestational age, and gender. At 4 months of age, 90% specificity for HIV diagnosis was associated with 60% sensitivity. For ease of use, graphical estimates based on cubic splines for the time-dependent parameters in a Box-Cox transformation (L), the median (M), and the coefficient of variation (S) were used to create LMS centile curves to show the sensitivity and specificity of CD4⁺/CD8⁺ T cell ratios in HIV-infected and uninfected infants until 12 months of age. At 6 months of age, a simplified equation that incorporated sequential CD4⁺/CD8⁺ T cell ratios and hematocrit values resulted in improved receiver operating characteristic curves, with 94% positive predictive value and 98% negative predictive value. The positive and negative predictive values remained above 90% in simulated infant populations over a wide range of HIV infection prevalence values.

CONCLUSIONS. In the absence of virological diagnosis, a presumptive diagnosis of HIV infection status can be made on the basis of CD4⁺/CD8⁺ T cell ratios in HIV-1-exposed infants after 2 months of age; sensitivity and specificity can be improved at 6 months by using a discriminant analysis equation.

---

Key Words: HIV diagnosis • perinatal HIV transmission • HIV-exposed infants • CD4⁺/CD8⁺ T cell ratio

Abbreviations: MTCT—mother-to-child transmission • LMS—least-mean squares • PCR—polymerase chain reaction • ROC—receiver operating characteristic • WITS—Women and Infants Transmission Study

---

Accepted Dec 12, 2007.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?