An Evaluation of Alternative Markers to Guide Initiation of Anti-retroviral Therapy in HIV-Infected Children in Settings where CD4 Assays are not Available

被引：1

作者：

Huibers, Minke H. W. ^{[1
]}

Moons, Peter ^{[2
]}

Maseko, Nelson ^{[3
]}

Gushu, Montfort B. ^{[3
]}

Wit, Ferdinand W. ^{[4
]}

Graham, Steve M. ^{[5
,6
]}

van Hensbroek, Michael Boele ^{[1
,4
]}

Calis, Job C. ^{[1
,7
]}

机构：

[1] Univ Amsterdam, Global Child Hlth Grp, Emma Children Hosp, Acad Med Ctr, NL-1012 WX Amsterdam, Netherlands

[2] Univ Malawi, Dept Paediat, Coll Med, Zomba, Malawi

[3] Minist Hlth, Queen Elizabeth Cent Hosp, Zomba, Malawi

[4] Univ Amsterdam, Amsterdam Inst Global Hlth Dev, NL-1012 WX Amsterdam, Netherlands

[5] Univ Melbourne, Ctr Int Child Hlth, Dept Paediat, Melbourne, Vic, Australia

[6] Royal Childrens Hosp, Murdoch Childrens Res Inst, Melbourne, Vic, Australia

[7] Univ Amsterdam, Pediat Intens Care, Emma Children Hosp, Acad Med Ctr, NL-1012 WX Amsterdam, Netherlands

来源：

JOURNAL OF TROPICAL PEDIATRICS | 2016年 / 62卷 / 01期

关键词：

HIV; CD4; total lymfocyte count; TOTAL LYMPHOCYTE COUNT; SERUM-ALBUMIN; PROGNOSTIC INDICATOR; GROWTH FAILURE; PREDICTORS; MORTALITY; SURVIVAL; ANEMIA; WOMEN; THROMBOCYTOPENIA;

D O I：

10.1093/tropej/fmv070

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Objectives: In settings where CD4 testing is not available, alternative markers to start paediatric anti-retroviral therapy (ART) could be used. A comprehensive evaluation of these markers has not been performed. Methods: Prospective cross-sectional study of HIV-infected Malawian children not eligible for ART based on clinical criteria. Associations between CD4 and alternative markers [haemoglobin, total lymphocyte count (TLC), serum albumin, thrombocytes and growth parameters] were analysed, and accuracy of existing and new cut-offs were evaluated. Results: In all, 417 children were enrolled. Of 261 children aged >= 5 years, 155 (59%) qualified to start ART using CD4. In this group, only TLC was associated with CD4 (p<0.001). Sensitivity for TLC was 21% (95% CI: 15-29%), using World Health Organization cut-offs. Improved cut-offs increased sensitivity to 73% (95% CI: 65-80%), specificity 62% (95% CI: 52-72%). Conclusion: Clinical staging alone is an unreliable strategy to start ART in children. TLC is the only alternative marker for CD4, cut-offs need to be revised though.

引用

页码：19 / 28

页数：10

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