Document Detail


Nonvirologic algorithms for predicting HIV infection among HIV-exposed infants younger than 12 weeks of age.
MedLine Citation:
PMID:  22935865     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Early initiation of antiretroviral therapy has been shown to reduce mortality among perinatally HIV-infected infants, but availability of virologic testing remains limited in many settings.
METHODS: We collected cross-sectional data from mother-infant pairs in three primary care clinics in Lusaka, Zambia, to develop predictive models for HIV infection among infants younger than 12 weeks of age. We evaluated algorithm performance for all possible combinations of selected characteristics using an iterative approach. In primary analysis, we identified the model with the highest combined sensitivity and specificity.
RESULTS: Between July 2009 and May 2011, 822 eligible HIV-infected mothers and their HIV-exposed infants were enrolled; of these, 44 (5.4%) infants had HIV diagnosed. We evaluated 382,155,260 different characteristic combinations for predicting infant HIV infection. The algorithm with the highest combined sensitivity and specificity required 5 of the following 7 characteristic thresholds: infant CD8 percentage >22; infant CD4 percentage ≤44; infant weight-for-age Z score ≤0; infant CD4 ≤1600 cells/µL; infant CD8 >2200 cells/µL; maternal CD4 ≤600 cells/µL; and mother not currently using antiretroviral therapy for HIV treatment. This combination had a sensitivity of 90.3%, specificity of 78.4%, positive predictive value of 22.4%, negative predictive value of 99.2% and area under the curve of 0.844.
CONCLUSION: Predicting HIV infection in HIV-exposed infants in this age group is difficult using clinical and immunologic characteristics. Expansion of polymerase chain reaction capacity in resource-limited settings remains urgently needed.
Authors:
Benjamin H Chi; Mohammed I Limbada; Mark J Giganti; Michelle S Li; Maximillian Bweupe; Patrick Musonda; Peggy Bubala; Mwangelwa Mubiana-Mbewe; Namwinga T Chintu; Carolyn Bolton-Moore; Jeffrey S A Stringer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  32     ISSN:  1532-0987     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-21     Completed Date:  2013-10-21     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  151-6     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Algorithms*
Analysis of Variance
Anti-Retroviral Agents / therapeutic use
Area Under Curve
CD4 Lymphocyte Count
Cross-Sectional Studies
Early Diagnosis
Female
HIV Infections / diagnosis,  drug therapy,  epidemiology,  transmission*
Humans
Infant
Infant, Newborn
Infectious Disease Transmission, Vertical*
Models, Biological*
Mothers / statistics & numerical data
Predictive Value of Tests
Pregnancy
Pregnancy Complications, Infectious / drug therapy
Reproducibility of Results
Grant Support
ID/Acronym/Agency:
D43 TW001035/TW/FIC NIH HHS; D43-TW001035/TW/FIC NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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