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CD4+ T-lymphocyte count/CD8+ T-lymphocyte count ratio: surrogate for HIV infection in infants?
Poorana Ganga Devi Navaneethapandian1, Ramesh Karunaianantham, Sudha Subramanyan
1National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India.
Insights
The CD4/CD8 ratio is an effective surrogate marker for diagnosing HIV in infants, especially in resource-limited settings. A ratio below 1.0 accurately identifies HIV infection, aiding early intervention in infants.
Area of Science:
- Immunology
- Pediatric Infectious Diseases
- Public Health
Background:
- Early diagnosis of HIV in infants is crucial to prevent progression to AIDS.
- Standard diagnostic methods like antibody testing and PCR have limitations in resource-poor settings.
- Accurate surrogate markers are needed for timely HIV diagnosis in infants.
Purpose of the Study:
- To evaluate the accuracy of CD4(+) T-lymphocyte count, CD4%, and CD4/CD8 ratio as surrogate markers for HIV infection in Indian infants.
- To determine the most sensitive and specific surrogate marker for early HIV detection in this population.
Main Methods:
- A study involving 258 HIV-exposed Indian infants (median age 5 months) was conducted.
- DNA PCR testing was performed alongside CD4 and CD8 counts for all infants.
- Data analysis focused on comparing CD4 counts, CD4%, and CD4/CD8 ratios between HIV-positive and HIV-negative infants.
Main Results:
- Fifty-five infants tested positive for HIV-1 DNA PCR, while 203 tested negative.
- Infants with HIV showed significantly lower median CD4 counts, CD4%, and CD4/CD8 ratios.
- A CD4/CD8 ratio <1.0 demonstrated high sensitivity (91%) and specificity (92%) for predicting HIV infection.
Conclusions:
- The CD4/CD8 ratio <1.0 is a highly sensitive and specific surrogate marker for identifying HIV infection in Indian infants.
- This marker is more effective than CD4 count <1500 cells/µl or CD4% <25% for early HIV diagnosis in infants.
- The CD4/CD8 ratio offers a valuable tool for HIV diagnosis in resource-limited settings where PCR may not be readily available.
Introduction:
Early diagnosis and treatment is necessary to prevent HIV-infected infants progressing to AIDS. Antibody testing is not confirmatory before the age of 18 months and PCR not widely available in resource-poor settings. We studied the accuracy of CD4(+) T-lymphocyte count, CD4% and CD4/CD8 ratio as surrogate markers of infant HIV infection.
Methods:
Two hundred and fifty-eight HIV-exposed Indian infants at a median age of 5 months (range 1-18) had DNA PCR and CD4, CD8 counts performed.
Results:
Fifty five infants tested positive by HIV-1 DNA PCR whereas 203 were negative. Median CD4 count, CD4% and CD4/CD8 ratio were significantly lower in DNA PCR+ infants. Overall sensitivity and specificity of CD4/CD8 ratio <1.0 in predicting HIV was 91 and 92% with a negative predicted value (NPV) and positive predicted value (PPV) of 97 and 76%, respectively.
Conclusion:
CD4/CD8 ratio <1.0 is a more sensitive surrogate marker of HIV infection in Indian infants than a CD4 count <1500 cells/µl or CD4% <25%.
