Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Dec;120(6):1449-56.
doi: 10.1016/j.jaci.2007.08.037. Epub 2007 Oct 17.

CD4/CD8 T-cell ratio predicts HIV infection in infants: the National Heart, Lung, and Blood Institute P2C2 Study

William T Shearer  1 , Savita Pahwa, Jennifer S Read, Jian Chen, Sameera R Wijayawardana, Paul Palumbo, Elaine J Abrams, Stephen R Nesheim, Wanrong Yin, Bruce Thompson, Kirk A Easley
Affiliations

CD4/CD8 T-cell ratio predicts HIV infection in infants: the National Heart, Lung, and Blood Institute P2C2 Study

William T Shearer et al. J Allergy Clin Immunol. 2007 Dec.

Abstract

Background: In resource-poor regions of the world, HIV virologic testing is not available.

Objective: We sought to evaluate the diagnostic usefulness of the CD4/CD8 T-cell ratio in predicting HIV infection in infants.

Methods: Data from the 3- and 9-month visits for non-breast-fed infants born to HIV-infected mothers enrolled (1990-1994) in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study (mother-to-child transmission of HIV, 17%) were analyzed. Data from the 3-month visit for infants enrolled (1985-1996) in the Perinatal AIDS Collaborative Transmission Study (mother-to-child transmission of HIV, 18%) were used for validation.

Results: At 3 months of age, data were available on 79 HIV-infected and 409 uninfected non-breast-fed infants in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study. The area under the curve (AUC) of the receiver operating characteristic curve at 3 months was higher for the CD4/CD8 ratio compared with the CD4(+) T-cell count (AUC, 0.83 and 0.75; P = .03). The mean CD4/CD8 ratio at the 3-month visit was 1.7 for HIV-infected infants and 3.0 for uninfected infants. A CD4/CD8 ratio of 2.4 at 3 months of age was almost 2.5 times more likely to occur in an HIV-infected infant compared with an uninfected infant (test sensitivity, 81%; posttest probability of HIV, 33%). Model performance in the Centers for Disease Control and Prevention Perinatal AIDS Collaborative Transmission Study validation test (224 HIV-infected and 1015 uninfected 3-month-old infants) was equally good (AUC, 0.78 for CD4/CD8 ratio).

Conclusion: The CD4/CD8 T-cell ratio is a more sensitive predictor of HIV infection in infants than the CD4(+) T-cell count.

Clinical implications: The CD4/CD8 T-cell ratio can be used with caution to predict HIV infection in children.

PubMed Disclaimer

Conflict of interest statement

Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

Figures

Figure 1
Figure 1
Mean CD4 cell count versus age (A) and mean CD4/CD8 ratio versus age (B) in infants born to HIV-infected mothers. In Fig 1, A, the mean CD4 cell count (in cells per microliter) at 1 week and 1, 3, 6, 9, and 12 months of age and the average rate of decrease of CD4 T-cell counts in the first year of life for HIV-infected infants and HIV-uninfected infants is shown. In Fig 1, B, similar data for CD4/CD8 ratio by HIV infection status are shown. Rates of CD4 T-cell count decrease and CD4/CD8 ratio decrease were significantly greater in HIV-infected infants compared with those seen in HIV-uninfected infants. Vertical bars, 95% CI.
Figure 2
Figure 2
Reference percentile curves for CD4/CD8 ratio by HIV status in the first 14 months of life.
Figure 3
Figure 3
ROC curves based on the P2C2 data for CD4 T-cell count and CD4/CD8 ratio. A, Three-month study visit. B, Nine-month study visit.
Figure 4
Figure 4
Predicted risk of HIV infection by CD4/CD8 ratio: P2C2 Study data versus validation (PACTS) data.
See this image and copyright information in PMC

References

    1. Gortmaker SL, Hughes M, Cervia J, Brady M, Johnson GM, Seage GR., 3rd Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1. N Engl J Med. 2001;345:1522–1528. - PubMed
    1. Gona P, Van Dyke RB, Williams PL, Dankner WM, Chernoff MC, Nachman SA, et al. Incidence of opportunistic and other infections in HIV-infected children in the HAART era. JAMA. 2006;296:292–300. - PubMed
    1. Palumbo P. Diagnostic methods for infants born to HIV-infected women. In: Shearer WT, Hanson IC, editors. Medical management of AIDS in children. Philadelphia: Elsevier/Saunders; 2003. pp. 107–116.
    1. Shearer WT, Easley KA, Goldfarb J, Rosenblatt HM, Jenson HB, Kovacs A, et al. Prospective 5-year study of peripheral blood CD4, CD8, and CD19/CD20 lymphocytes and serum Igs in children born to HIV-1 women. The P2C2 HIV Study Group. J Allergy Clin Immunol. 2000;106:559–566. - PMC - PubMed
    1. Chinen J, Easley KA, Mendez H, Shearer WT. Decline of CD3-positive T-cell counts by 6 months of age is associated with rapid disease progression in HIV-1-infected infants. J Allergy Clin Immunol. 2001;108:265–268. - PMC - PubMed

Publication types