CD4 +/CD8 +T cell ratio for diagnosis of HIV-1 infection in infants: Women and infants transmission study

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

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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 (US)
Pages (from-to)331-339
Number of pages9
Issue number2
StatePublished - Aug 2008


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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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