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Journal of Tropical Pediatrics Advance Access originally published online on June 16, 2006
Journal of Tropical Pediatrics 2006 52(5):346-354; doi:10.1093/tropej/fml024
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© The Author [2006]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

CD4 Percentages and Total Lymphocyte Counts as Early Surrogate Markers for Pediatric HIV-1 Infection in Resource-Limited Settings

François Roueta,, André Inwoleya, Didier K. Ekouevib,c, Ida Vihob, Renaud Becquetc, Charlotte Sakarovitchc, Laurence Bequetb, Besigin Tonwe-Goldd, Marie-Laure Chaixe, Valériane Leroyc, Christine Rouziouxe, François Dabisc and the ANRS 1201/1202 Ditrame Plus Study Group*

aCentre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
bProjet ANRS 1201/1202 Ditrame plus, Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
cINSERM unité 593, Institut de Santé Publique Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France
dMTCT Plus Initiative, Association ACONDA-VS, Abidjan, Côte d’Ivoire
eLaboratoire de Virologie, EA 3620 Université René Descartes, Centre Hospitalier Universitaire Necker Enfants Malades, Paris, France
* See Appendix for details

Correspondence: Dr François Rouet, Laboratoire de Virologie, Centre MURAZ 01, BP 390 Bobo-Dioulasso, Burkina Faso.E-mail < franrouet{at}yahoo.fr; Renaud.Becquet{at}isped.u-bordeaux2.fr>

The early diagnosis of pediatric HIV-1 infection is a critical issue in resource-limited settings to prioritize eligibility for antiretroviral therapy among HIV-1-infected children. A case-control study was performed within the ANRS 1201/1202 Ditrame Plus cohort (Abidjan, Côte d’Ivoire) to assess the usefulness of CD4+ T-cell percentage (CD4%) and total lymphocyte count (TLC) measured early in life in African children born to HIV-1-infected mothers. Using plasma HIV-1 RNA testing at 4 weeks of life as gold standard, CD4% and TLC were determined at month 3 and 6 in all 33 children HIV-1-infected in utero or intrapartum/early postpartum (cases) born to mothers receiving peripartum antiretroviral prophylaxis. Controls were 66 HIV-1-uninfected children from the same cohort. At month 3, the median CD4% was significantly lower in HIV-1-infected children (17.7%, 95% percentiles, 7.1–27.4) than in uninfected controls (34.8%, 18.5–45.3) (P < 0.001). A comparable difference was also observed at month 6. At the same time points, no significant difference was measurable for TLCs. The best threshold differentiating HIV-infected and uninfected children at month 3 was 25% CD4+. Compared to HIV-1 RNA results, sensitivity of this marker was 87.1% (95% confidence interval, 70.2–96.4) at month 3 and 88.9% (70.8–97.6) at month 6. Specificity was 78.3% (63.6–89.0) and 88.3% (77.4–95.2), respectively. Early CD4% measurement allows one to classify adequately the vast majority of exposed children according to their HIV status. CD4% should be further evaluated under field conditions for the diagnosis of pediatric HIV-1 infection and the monitoring of pediatric antiretroviral therapy.


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J. S. Read and and the Committee on Pediatric AIDS
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