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1.
J Trop Pediatr ; 62(1): 19-28, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26491058

RESUMO

OBJECTIVES: In settings where CD4 testing is not available, alternative markers to start paediatric anti-retroviral therapy (ART) could be used. A comprehensive evaluation of these markers has not been performed. METHODS: Prospective cross-sectional study of HIV-infected Malawian children not eligible for ART based on clinical criteria. Associations between CD4 and alternative markers [haemoglobin, total lymphocyte count (TLC), serum albumin, thrombocytes and growth parameters] were analysed, and accuracy of existing and new cut-offs were evaluated. RESULTS: In all, 417 children were enrolled. Of 261 children aged ≥5 years, 155 (59%) qualified to start ART using CD4. In this group, only TLC was associated with CD4 (p < 0.001). Sensitivity for TLC was 21% (95% CI: 15-29%), using World Health Organization cut-offs. Improved cut-offs increased sensitivity to 73% (95% CI: 65-80%), specificity 62% (95% CI: 52-72%). CONCLUSION: Clinical staging alone is an unreliable strategy to start ART in children. TLC is the only alternative marker for CD4, cut-offs need to be revised though.


Assuntos
Antirretrovirais/uso terapêutico , Biomarcadores , Infecções por HIV/tratamento farmacológico , Contagem de Linfócitos , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Estudos Transversais , Sistemas de Apoio a Decisões Clínicas , Feminino , Infecções por HIV/virologia , Soropositividade para HIV , Humanos , Malaui , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Organização Mundial da Saúde
2.
J Clin Pathol ; 67(8): 717-23, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24915849

RESUMO

AIM: Iron deficiency is an important child health problem. Its diagnosis in areas of high infection exposure remains complicated as inflammation may interfere with the accuracy of peripheral iron markers. With this study, we aimed to validate the conventional iron markers and two novel iron markers, hepcidin and Red blood cell Size Factor (RSf), against the reference standard of iron status, bone marrow iron, in children living in an infectious setting. METHODS: We compared ferritin, soluble transferrin receptor, Soluble Transferrin Log-Ferritin Index (sTfR-F), mean cellular volume, mean cellular haemoglobin concentration, hepcidin and RSf, against bone marrow iron in 87 healthy Malawian children (6-66 months) scheduled for elective surgery. RESULTS: Of all children, 44.8% had depleted bone marrow iron stores. Using optimised cut-offs, ferritin (<18 µg/L) and sTfR-F (>1.85) best predicted depleted iron stores with a sensitivity/specificity of 73.7%/77.1% and 72.5%/75.0%, respectively. Hepcidin (<1.4 nmol/L) was a moderate sensitive marker (73.0%) although specificity was 54.2%; RSf poorly predicted depleted iron stores. CONCLUSIONS: We provide the first bone marrow-validated data on peripheral iron markers in African children, and showed ferritin and sTfR-F best predicted iron status. Using appropriately defined cut-offs, these indicators can be applied in surveillance and research. As their accuracy is limited for clinical purposes, more reliable iron biomarkers are still required in African children.


Assuntos
Anemia Ferropriva/diagnóstico , Medula Óssea/química , Hepcidinas/sangue , Ferro/análise , Anemia Ferropriva/sangue , Biomarcadores/sangue , Pré-Escolar , Índices de Eritrócitos , Feminino , Ferritinas/sangue , Humanos , Lactente , Ferro/sangue , Deficiências de Ferro , Malaui , Masculino , Receptores da Transferrina/sangue , Transferrina
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