Minke H W Huibers1, Peter Moons2, Nelson Maseko3, Montfort B Gushu3, Ferdinand W Wit4, Steve M Graham5, Michael Boele van Hensbroek6, Job C Calis7. 1. Global Child Health Group, Emma Children Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands Mhw.huibers@gmail.com. 2. Department of Paediatrics, University of Malawi College of Medicine, Malawi. 3. Queen Elizabeth Central Hospital, Ministry of Health, Malawi. 4. Amsterdam Institute of Global Health Development (AIGHD), University of Amsterdam, The Netherlands. 5. Centre for International Child Health, University of Melbourne, Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia. 6. Global Child Health Group, Emma Children Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands Amsterdam Institute of Global Health Development (AIGHD), University of Amsterdam, The Netherlands. 7. Global Child Health Group, Emma Children Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands Pediatric Intensive Care, Emma Children Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands.
Abstract
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.
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 Malawianchildren 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.
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