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Predictive value of CD19 measurements for bacterial infections in children infected with human immunodeficiency virus
R A Betensky1, T Calvelli, S Pahwa
1Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts 02115, USA. betensky@hsph.harvard.edu
Insights
CD19 cell percentages (CD19%) combined with IgG levels can predict bacterial infections in children. CD4% is a stronger predictor, but CD19% and IgG together offer valuable prognostic insights.
Area of Science:
- Immunology
- Pediatric Infectious Diseases
- Clinical Trials
Background:
- Bacterial infections pose a significant risk in pediatric populations, particularly those with compromised immune systems.
- Understanding predictive markers for infection is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To evaluate the predictive value of CD19 cell percentages (CD19%) for the time to bacterial infections in children.
- To explore the combined prognostic effects of CD19% and immunoglobulin G (IgG) levels on infection risk.
- To compare the predictive power of CD19% and IgG with CD4% in assessing bacterial infection risk.
Main Methods:
- Analysis of data from six pediatric AIDS Clinical Trials Group (ACTG) protocols.
- Statistical adjustment for prognostic variables including CD4%, CD8%, IgA, lymphocyte count, prior infections, prior zidovudine treatment, and age.
- Exploration of baseline and longitudinal changes in CD19% and IgG levels.
Main Results:
- Low CD19% showed a nonsignificant increase in bacterial infection hazard.
- High IgG levels demonstrated a nonsignificant decrease in infection hazard.
- CD4% was a more significant predictor of bacterial infection than CD19% or IgG alone.
- The combination of low CD19% and high IgG levels significantly decreased infection hazard (P < 0.01).
- Increasing CD19% was associated with decreased infection hazard, while increasing CD19% and IgG together significantly increased infection hazard (P = 0.01).
Conclusions:
- CD19% in conjunction with IgG level serves as a valuable prognostic tool for bacterial infections in children.
- The interplay between CD4% (T-helper function) and B-cell function (CD19%) likely influences bacterial infection risk.
- Incorporating CD4% into analyses may enhance the assessment of bacterial infection risk.
Abstract:
We investigated the predictive value of CD19 cell percentages (CD19%) for times to bacterial infections, using data from six pediatric AIDS Clinical Trials Group protocols and adjusting for other potentially prognostic variables, such as CD4%, CD8%, immunoglobulin (IgA) level, lymphocyte count, prior infections, prior zidovudine treatment, and age. In addition, we explored the combined effects of CD19% and IgG level in predicting time to infection. We found that a low CD19% is associated with a nonsignificant 1.2-fold increase in hazard of bacterial infection (95% confidence interval: 0.97, 1.49). In contrast, a high IgG level is associated with a nonsignificant 0.87-fold decrease in hazard of infection (95% confidence interval: 0.68, 1.12). CD4% was more prognostic of time to bacterial infection than CD19% or IgG level. Low CD19% and high IgG levels together lead to a significant (P < 0. 01) 0.50-fold decrease in hazard (95% confidence interval: 0.35, 0. 73) relative to low CD19% and low IgG levels. Similarly, in a model involving assay result changes (from baseline to 6 months) as well as baseline values, the effect of CD19% by itself is reversed from its effect in conjunction with IgG. In this model, CD19% that are increasing and high are associated with decreases in hazard of infection (P < 0.01), while increasing CD19% and increasing IgG levels are associated with significant (at the P = 0.01 level) fourfold increases in hazard of infection relative to stable CD19% and decreasing, stable, or increasing IgG levels. Our data suggest that CD19%, in conjunction with IgG level, provides a useful prognostic tool for bacterial infections. It is highly likely that T-helper function impacts on B-cell function; thus, inclusion of CD4% in such analyses may greatly enhance the assessment of risk for bacterial infection.
