An Evaluation of Alternative Markers to Guide Initiation of Anti-retroviral Therapy in HIV-Infected Children in Settings where CD4 Assays are not Available.
J Trop Pediatr
; 62(1): 19-28, 2016 Feb.
Article
en En
| MEDLINE
| ID: mdl-26491058
ABSTRACT
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.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Biomarcadores
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Infecciones por VIH
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Recuento de Linfocitos
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Antirretrovirales
Tipo de estudio:
Diagnostic_studies
/
Evaluation_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Child
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Child, preschool
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Female
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Humans
/
Male
País/Región como asunto:
Africa
Idioma:
En
Revista:
J Trop Pediatr
Año:
2016
Tipo del documento:
Article
País de afiliación:
Países Bajos