title: CD4 percentages and total lymphocyte counts as early surrogate markers for pediatric HIV-1 infection in resource-limited settings.
abstract: The early diagnosis of pediatric HIV-1 infection is a critical issue in resource-limited settings to prioritize eligibility for antiretroviral therapy among HIV-1-infected children. A case-control study was performed within the ANRS 1201/1202 Ditrame Plus cohort (Abidjan, Côte d'Ivoire) to assess the usefulness of CD4+ T-cell percentage (CD4%) and total lymphocyte count (TLC) measured early in life in African children born to HIV-1-infected mothers. Using plasma HIV-1 RNA testing at 4 weeks of life as gold standard, CD4% and TLC were determined at month 3 and 6 in all 33 children HIV-1-infected in utero or intrapartum/early postpartum (cases) born to mothers receiving peripartum antiretroviral prophylaxis. Controls were 66 HIV-1-uninfected children from the same cohort. At month 3, the median CD4% was significantly lower in HIV-1-infected children (17.7%, 95% percentiles, 7.1-27.4) than in uninfected controls (34.8%, 18.5-45.3) (P < 0.001). A comparable difference was also observed at month 6. At the same time points, no significant difference was measurable for TLCs. The best threshold differentiating HIV-infected and uninfected children at month 3 was 25% CD4+. Compared to HIV-1 RNA results, sensitivity of this marker was 87.1% (95% confidence interval, 70.2-96.4) at month 3 and 88.9% (70.8-97.6) at month 6. Specificity was 78.3% (63.6-89.0) and 88.3% (77.4-95.2), respectively. Early CD4% measurement allows one to classify adequately the vast majority of exposed children according to their HIV status. CD4% should be further evaluated under field conditions for the diagnosis of pediatric HIV-1 infection and the monitoring of pediatric antiretroviral therapy.
authors.affiliation: Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire. franrouet@yahoo.fr
authors.forename: François
authors.initials: F
authors.lastname: Rouet
authors.forename: André
authors.initials: A
authors.lastname: Inwoley
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: Ida
authors.initials: I
authors.lastname: Viho
authors.forename: Renaud
authors.initials: R
authors.lastname: Becquet
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sakarovitch
authors.forename: Laurence
authors.initials: L
authors.lastname: Bequet
authors.forename: Besigin
authors.initials: B
authors.lastname: Tonwe-Gold
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Chaix
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: François
authors.initials: F
authors.lastname: Dabis
mesh_terms: D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D007560:Cote d'Ivoire; D003906:Developing Countries; D005434:Flow Cytometry; D015658:HIV Infections / Q000151:congenital* / Q000175:diagnosis* / Q000276:immunology / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D018655:Lymphocyte Count; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity