CD4 +/CD8 +T cell ratio for diagnosis of HIV-1 infection in infants

Women and infants transmission study

Savita G Pahwa, Jennifer S. Read, Wanrong Yin, Yvonne Matthews, William Shearer, Clemente Diaz, Kenneth Rich, Hermann Mendez, Bruce Thompson

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)331-339
Number of pages9
JournalPediatrics
Volume122
Issue number2
DOIs
StatePublished - Aug 1 2008

Fingerprint

HIV Infections
HIV-1
T-Lymphocytes
HIV
ROC Curve
Sensitivity and Specificity
Discriminant Analysis
Hematocrit
Birth Weight
Gestational Age
Mothers
Population

Keywords

  • CD4 /cD8 tcell ratio
  • HIV diagnosis
  • HIV-exposed infants
  • Perinatal HIV transmission

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

CD4 +/CD8 +T cell ratio for diagnosis of HIV-1 infection in infants : Women and infants transmission study. / Pahwa, Savita G; Read, Jennifer S.; Yin, Wanrong; Matthews, Yvonne; Shearer, William; Diaz, Clemente; Rich, Kenneth; Mendez, Hermann; Thompson, Bruce.

In: Pediatrics, Vol. 122, No. 2, 01.08.2008, p. 331-339.

Research output: Contribution to journalArticle

Pahwa, SG, Read, JS, Yin, W, Matthews, Y, Shearer, W, Diaz, C, Rich, K, Mendez, H & Thompson, B 2008, 'CD4 +/CD8 +T cell ratio for diagnosis of HIV-1 infection in infants: Women and infants transmission study', Pediatrics, vol. 122, no. 2, pp. 331-339. https://doi.org/10.1542/peds.2007-2308
Pahwa, Savita G ; Read, Jennifer S. ; Yin, Wanrong ; Matthews, Yvonne ; Shearer, William ; Diaz, Clemente ; Rich, Kenneth ; Mendez, Hermann ; Thompson, Bruce. / CD4 +/CD8 +T cell ratio for diagnosis of HIV-1 infection in infants : Women and infants transmission study. In: Pediatrics. 2008 ; Vol. 122, No. 2. pp. 331-339.
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abstract = "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.",
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AU - Yin, Wanrong

AU - Matthews, Yvonne

AU - Shearer, William

AU - Diaz, Clemente

AU - Rich, Kenneth

AU - Mendez, Hermann

AU - Thompson, Bruce

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N2 - 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.

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