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Alternatives to HIV-1 RNA concentration and CD4 count to predict mortality in HIV-1-infected children in
L M Mofenson1, D R Harris, J Moye
1Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Boulevard, Rockville, MD 20852, USA. lm65d@nih.gov
Insights
Simple blood tests like total lymphocyte count and serum albumin can predict mortality in children with HIV-1 infection. These findings offer valuable prognostic tools for resource-limited settings lacking advanced diagnostics.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Prognostics
Background:
- Resource-limited settings require cost-effective biomarkers for HIV-1 prognosis.
- Current prognostic markers like CD4 counts and HIV-1 RNA detection are often inaccessible in these areas.
- The predictive value of alternative assays, especially in pediatric populations, remains underexplored.
Purpose of the Study:
- To evaluate the prognostic utility of alternative biomarkers for mortality prediction in HIV-1-infected children.
- To identify simpler, cheaper assays that can substitute for CD4 lymphocyte count and HIV-1 RNA detection.
Main Methods:
- A cohort of 376 HIV-1-infected children was studied.
- Prognostic value of total lymphocyte count, immune complex-dissociated p24 antigen, white blood cell count, packed-cell volume (hematocrit), and serum albumin for mortality was assessed.
- Cox proportional hazards models were employed to analyze the data.
Main Results:
- Total lymphocyte count (p<0.0001) and serum albumin (p=0.0107) independently predicted mortality in HIV-1-infected children.
- These markers demonstrated significant prognostic value in multivariate analysis.
- Other assessed markers did not show independent predictive value in this cohort.
Conclusions:
- Total lymphocyte count and serum albumin are valuable, accessible prognostic markers for HIV-1-infected children.
- These biomarkers can aid in assessing prognosis in resource-poor settings.
- Further validation of these alternative assays in resource-limited environments is recommended.
Abstract:
Cheaper, simpler alternatives to CD4 lymphocyte count and HIV-1 RNA detection for assessing the prognosis of HIV-1 infection are needed for resource-poor settings. However, little is known about the predictive value of alternative assays, in particular in children. We assessed the prognostic value of total lymphocyte count, immune complex-dissociated p24 antigen, white blood cell count, packed-cell volume (haematocrit), and serum albumin for mortality in 376 HIV-1-infected, mainly African-American or Hispanic children enrolled during March, 1988 to January, 1991. In a Cox proportional hazards model, including all assay-alternatives to CD4 and RNA, total lymphocyte count (p<0.0001) and serum albumin (p=0.0107) independently predicted mortality. Further assessment of these markers is warranted in resource-poor settings.
