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Bull World Health Organ. 2011 Jul 1;89(7):513-20. doi: 10.2471/BLT.11.085977. Epub 2011 Apr 28.
To develop a new algorithm for the presumptive diagnosis of severe disease associated with human immunodeficiency virus (HIV) infection in children less than 18 months of age for the purpose of identifying children who require antiretroviral therapy (ART).
A conditional probability model was constructed and non-virologic parameters in various combinations were tested in a hypothetical cohort of 1000 children aged 6 weeks, 6 months and 12 months to assess the sensitivity, specificity, and positive and negative predictive values of these algorithms for identifying children in need of ART. The modelled parameters consisted of clinical criteria, rapid HIV antibody testing and CD4+ T-lymphocyte (CD4) count.
In children younger than 18 months, the best-performing screening algorithm, consisting of clinical symptoms plus antibody testing plus CD4 count, showed a sensitivity ranging from 71% to 80% and a specificity ranging from 92% to 99%. Positive and negative predictive values were between 61% and 97% and between 95% and 96%, respectively. In the absence of virologic tests, this alternate algorithm for the presumptive diagnosis of severe HIV disease makes it possible to correctly initiate ART in 91% to 98% of HIV-positive children who are at highest risk of dying.
The algorithms presented in this paper have better sensitivity and specificity than clinical parameters, with or without rapid HIV testing, for the presumptive diagnosis of severe disease in HIV-positive children less than 18 months of age. If implemented, they can increase the number of HIV-positive children successfully initiated on ART.
为了明确需要抗逆转录病毒治疗（ART）的患儿，建立一种新的算法，以用于预测 18 月龄以下人类免疫缺陷病毒（HIV）感染相关严重疾病。
建立条件概率模型，在一个假设的 1000 名 6 周龄、6 月龄和 12 月龄儿童队列中测试不同组合的非病毒学参数，以评估这些算法对需要 ART 的患儿的敏感性、特异性、阳性预测值和阴性预测值。建模参数包括临床标准、快速 HIV 抗体检测和 CD4+T 淋巴细胞（CD4）计数。
18 月龄以下儿童中，性能最佳的筛查算法是由临床症状、抗体检测和 CD4 计数组成的算法，其敏感性为 71%80%，特异性为 92%99%。阳性预测值为 61%97%，阴性预测值为 95%96%。在没有病毒学检测的情况下，这种替代的严重 HIV 疾病的推测性诊断算法可使处于高死亡风险的 91%~98%HIV 阳性患儿正确开始 ART。
本文提出的算法在预测 18 月龄以下 HIV 阳性儿童严重疾病方面，其敏感性和特异性优于临床参数，且无论是否进行快速 HIV 检测，都具有良好的效果。如果实施，可增加接受 ART 的 HIV 阳性患儿数量。
