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The α-test: Rapid Cell-free CD4 Enumeration Using Whole Saliva
Published on: May 16, 2012
Absolute CD4+ T-lymphocyte count as a surrogate marker of pediatric human immunodeficiency virus disease progression
Elijah Paintsil1, Musie Ghebremichael, Sostena Romano
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA. elijah.paintsil@yale.edu
Insights
Absolute CD4+ T-lymphocyte counts reliably monitor pediatric HIV progression, offering an accessible alternative to percentages. This finding is crucial for resource-limited settings managing pediatric HIV.
Area of Science:
- Immunology
- Virology
- Pediatrics
Background:
- Pediatric HIV monitoring traditionally uses CD4+ T-lymphocyte percentage due to absolute count variability.
- Resource-limited settings often rely on absolute CD4+ T-lymphocyte counts due to equipment costs and complexity.
- This study evaluates absolute CD4+ T-lymphocyte count as a surrogate for pediatric HIV disease progression.
Purpose of the Study:
- To assess the reliability of absolute CD4+ T-lymphocyte count as a surrogate marker for pediatric HIV disease progression.
- To compare the effectiveness of absolute CD4+ T-lymphocyte count with CD4+ T-lymphocyte percentage in monitoring HIV in children.
- To identify factors associated with CD4+ T-lymphocyte counts and HIV viral load in children.
Main Methods:
- Longitudinal analysis of 97 HIV-infected children over 10 years (1996-2006).
- Generalized linear mixed models used to analyze CD4+ T-lymphocytes and HIV viral load trends.
- Data collected at baseline and every 2-3 months, with participant-specific outcome variable changes modeled.
Main Results:
- Absolute CD4+ T-lymphocyte count demonstrated reliability comparable to CD4+ T-lymphocyte percentage in monitoring pediatric HIV.
- Antiretroviral treatment was associated with significantly higher CD4+ T-lymphocyte counts (P < 0.01).
- Race (lower for Black children, P < 0.01) and co-infections (associated with lower CD4+ counts and higher viral load, P = 0.01) were significant factors.
Conclusions:
- Absolute CD4+ T-lymphocyte count serves as an affordable and accessible surrogate marker for HIV disease progression in children.
- This method is particularly valuable in settings where CD4+ T-lymphocyte percentage determination is not feasible.
- The findings support the use of absolute CD4+ counts for effective pediatric HIV management in resource-constrained environments.
Background:
Traditionally in pediatric HIV, the CD4+ T-lymphocyte percent is used to monitor disease progression because of the variability in absolute CD4+ T-lymphocyte numbers. Because of the high cost of equipment, sophisticated and delicate technology, most laboratories in resource-limited settings use simple protocols that enumerate only the absolute CD4+ T-lymphocyte counts. We assessed the use of absolute CD4+ T-lymphocyte count as a surrogate marker of pediatric HIV disease progression.
Methods:
We analyzed the CD4+ T-lymphocytes and HIV viral load over a 10-year period (1996-2006) of 97 HIV-infected children enrolled in the Yale Prospective Longitudinal Pediatric HIV Cohort using generalized linear mixed models. Both CD4+ T-lymphocytes and HIV viral load were assessed at baseline and every 2-3 months. The modeling approach used in this study allows the intercept and the rate at which outcome variables change over time to vary across participants.
Results:
We determined that absolute CD4+ T-lymphocytes count was just as reliable at monitoring pediatric HIV as CD4+ T-lymphocyte percentage. Antiretroviral treatment, regardless of the regimen used, was associated with higher CD+ T-lymphocytes count (P < 0.01). Race was significantly associated with CD4+ T-lymphocytes counts (with lower values for blacks compared with nonblacks; P < 0.01). The presence of other infections was associated with lower CD4+ T-lymphocyte count (P = 0.01) and higher viral load (P < 0.01), respectively.
Conclusions:
In situations where determination of CD4+ T-lymphocyte percentages is not readily available, the absolute count may provide an affordable and accessible laboratory surrogate marker of HIV disease progression in children.
