CD4/CD8 T-cell ratio predicts HIV infection in infants: The National Heart, Lung, and Blood Institute P2C2 Study

William T. Shearer, Savita G Pahwa, Jennifer S. Read, Jian Chen, Sameera R. Wijayawardana, Paul Palumbo, Elaine J. Abrams, Stephen R. Nesheim, Wanrong Yin, Bruce Thompson, Kirk A. Easley

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: In resource-poor regions of the world, HIV virologic testing is not available. Objective: We sought to evaluate the diagnostic usefulness of the CD4/CD8 T-cell ratio in predicting HIV infection in infants. Methods: Data from the 3- and 9-month visits for non-breast-fed infants born to HIV-infected mothers enrolled (1990-1994) in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study (mother-to-child transmission of HIV, 17%) were analyzed. Data from the 3-month visit for infants enrolled (1985-1996) in the Perinatal AIDS Collaborative Transmission Study (mother-to-child transmission of HIV, 18%) were used for validation. Results: At 3 months of age, data were available on 79 HIV-infected and 409 uninfected non-breast-fed infants in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study. The area under the curve (AUC) of the receiver operating characteristic curve at 3 months was higher for the CD4/CD8 ratio compared with the CD4+ T-cell count (AUC, 0.83 and 0.75; P = .03). The mean CD4/CD8 ratio at the 3-month visit was 1.7 for HIV-infected infants and 3.0 for uninfected infants. A CD4/CD8 ratio of 2.4 at 3 months of age was almost 2.5 times more likely to occur in an HIV-infected infant compared with an uninfected infant (test sensitivity, 81%; posttest probability of HIV, 33%). Model performance in the Centers for Disease Control and Prevention Perinatal AIDS Collaborative Transmission Study validation test (224 HIV-infected and 1015 uninfected 3-month-old infants) was equally good (AUC, 0.78 for CD4/CD8 ratio). Conclusion: The CD4/CD8 T-cell ratio is a more sensitive predictor of HIV infection in infants than the CD4+ T-cell count. Clinical implications: The CD4/CD8 T-cell ratio can be used with caution to predict HIV infection in children.

Original languageEnglish
Pages (from-to)1449-1456
Number of pages8
JournalJournal of Allergy and Clinical Immunology
Volume120
Issue number6
DOIs
StatePublished - Dec 1 2007

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Keywords

  • CD4/CD8 T-cell ratio
  • HIV infection
  • mother-to-child transmission of HIV

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Shearer, W. T., Pahwa, S. G., Read, J. S., Chen, J., Wijayawardana, S. R., Palumbo, P., Abrams, E. J., Nesheim, S. R., Yin, W., Thompson, B., & Easley, K. A. (2007). CD4/CD8 T-cell ratio predicts HIV infection in infants: The National Heart, Lung, and Blood Institute P2C2 Study. Journal of Allergy and Clinical Immunology, 120(6), 1449-1456. https://doi.org/10.1016/j.jaci.2007.08.037