CD4+/CD8+ T cell ratio for diagnosis of HIV-1 infection in infants: Women and Infants Transmission Study.
CD4+/CD8+ T cell ratio for diagnosis of HIV-1 infection in infants: Women and Infants Transmission Study.
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DOI：
10.1542/peds.2007-2308
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发表时间：
2008-08
期刊：
影响因子：
8
通讯作者：
Women and Infants Transmission Study
中科院分区：
文献类型：
--
作者：
Pahwa S;Read JS;Yin W;Matthews Y;Shearer W;Diaz C;Rich K;Mendez H;Thompson B;Women and Infants Transmission Study
对围产期HIV暴露的婴儿进行HIV感染的早期诊断对临床管理决策至关重要。艾滋病毒核酸检测阳性是诊断18个月前婴儿艾滋病毒感染状况的金标准，但这种检测并不是普遍可用的，特别是在世界资源匮乏的地区。在这项研究中，我们测试了CD4/CD8 T细胞比率可以预测HIV暴露婴儿的HIV感染状态的假设。从妇女和婴儿传播研究(WITS)中预期登记的活体出生的独生儿的数据中确定了CD4/CD8 T细胞比率。对2208名已知HIV感染状况的婴儿(179名HIV感染者，2029名未感染者)的资料进行了分析。受试者工作特征(ROC)曲线显示，CD_4/CD_8比值在2个月大时诊断HIV感染方面优于CD_4%(p=0.018)，并且这种关系不受母亲种族/民族、婴儿出生体重、胎龄和性别调整的影响。在4个月时，诊断HIV的90%的特异性与60%的敏感性相关。为了便于使用，基于纵向LMS分布的百分位数曲线被开发用于HIV感染和未感染的婴儿直到12个月的CD4/CD8比率的敏感性/特异性。在6个月大时，合并顺序的CD4/CD8比率和红细胞压积的简化方程导致改善的ROC，阳性预测值(PPV)为94%，阴性预测值(NPV)为98%。在HIV感染的广泛流行范围内，模拟婴儿人群的PPV和NPV保持在90%以上。在没有病毒学诊断的情况下，可以根据2个月后暴露于HIV-1的婴儿的CD4/CD8比率来推定HIV感染状态；使用判别分析方程可以在6个月时进一步提高敏感性和特异性。
Early diagnosis of HIV infection in infants with perinatal HIV exposure is critical for clinical management decisions. Positive HIV nucleic acid detection represents the gold standard for the diagnosis of HIV infection status in infants prior to age 18 months, but this test is not universally available, especially in resource poor regions of the world. In this study we tested the hypothesis that the CD4/CD8 T cell ratio can predict HIV infection status in HIV-exposed infants. CD4/CD8 T cell ratios were determined from data of live born, singleton infants who had been prospectively enrolled in the Women and Infants Transmission Study (WITS). Data from 2208 infants with known HIV infection status (179 HIV infected, 2029 uninfected) were analyzed. Receiver Operating Characteristic (ROC) curves indicated that CD4/CD8 ratio performed better than CD4% for diagnosis of HIV infection as early as age 2 months (p=0.018), and this relationship was unaffected by adjusting for maternal race/ethnicity, infant birth weight, gestational age and gender. At age 4 mos., 90% specificity for HIV diagnosis was associated with 60% sensitivity. For ease of utilization, longitudinal LMS profile-based percentile curves were developed for sensitivity/specificity of CD4/CD8 ratios in HIV-infected and -uninfected infants until age 12 months. At age 6 months, a simplified equation that incorporated sequential CD4/CD8 ratios and hematocrit values resulted in improved ROCs with 94% positive predictive value (PPV) and 98% negative predictive value (NPV). The PPV and NPV remained above 90% in simulated infant populations over a wide range of prevalence of HIV infection. In the absence of virologic diagnosis, a presumptive diagnosis of HIV- infection status may be made on the basis of CD4/CD8 ratios in HIV-1-exposed infants after age 2 months; sensitivity and specificity can be further improved at 6 months by using a discriminant analysis equation.