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

William T. Shearer, Savita 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 (US)
Pages (from-to)1449-1456
Number of pages8
JournalJournal of Allergy and Clinical Immunology
Volume120
Issue number6
DOIs
StatePublished - Dec 1 2007

Keywords

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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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    Shearer, W. T., Pahwa, S., 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