Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
Pediatr Infect Dis J. 2013 Feb;32(2):151-6. doi: 10.1097/INF.0b013e31827010a0.
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.
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.
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.
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.
早期启动抗逆转录病毒治疗已被证明可降低围产期感染艾滋病毒婴儿的死亡率，但在许多环境中，病毒学检测的可用性仍然有限。
我们从赞比亚卢萨卡的三个初级保健诊所的母婴对中收集了横断面数据，以开发针对 12 周龄以下婴儿的艾滋病毒感染预测模型。我们使用迭代方法评估了所有选定特征的可能组合的算法性能。在主要分析中，我们确定了具有最高综合敏感性和特异性的模型。
2009 年 7 月至 2011 年 5 月期间，共纳入 822 名符合条件的 HIV 感染母亲及其 HIV 暴露婴儿；其中 44 名（5.4%）婴儿被诊断为 HIV 感染。我们评估了 382,155,260 种不同的特征组合来预测婴儿 HIV 感染。具有最高综合敏感性和特异性的算法需要以下 7 个特征阈值中的 5 个：婴儿 CD8 百分比>22%；婴儿 CD4 百分比≤44%；婴儿体重-年龄 Z 评分≤0；婴儿 CD4≤1600 个细胞/µL；婴儿 CD8>2200 个细胞/µL；母亲 CD4≤600 个细胞/µL；母亲目前未接受抗逆转录病毒治疗治疗 HIV。这种组合的敏感性为 90.3%，特异性为 78.4%，阳性预测值为 22.4%，阴性预测值为 99.2%，曲线下面积为 0.844。
使用临床和免疫特征预测该年龄段 HIV 暴露婴儿的 HIV 感染是困难的。在资源有限的环境中，迫切需要扩大聚合酶链反应能力。
