Computed CD4 percentage as a low-cost method for determining pediatric antiretroviral treatment eligibility

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  • Callens, Steven FJ
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Kitetele, Faustin
    • Other Affiliation: School of Public Health, University of Kinshasa, Democratic Republic of the Congo
  • Lusiama, Jean
    • Other Affiliation: School of Public Health, University of Kinshasa, Democratic Republic of the Congo
  • Shabani, Nicole
    • Other Affiliation: School of Public Health, University of Kinshasa, Democratic Republic of the Congo
  • Edidi, Samuel
    • Other Affiliation: National AIDS Reference Laboratory, Kinshasa, Democratic Republic of the Congo
  • Colebunders, Robert
    • Other Affiliation: Institute of Tropical Medicine, Antwerp, Belgium and University of Antwerp, Belgium
  • Behets, Frieda
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Van Rie, Annelies
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Abstract Background The performance of the WHO recommendations for pediatric antiretroviral treatment (ART) in resource poor settings is insufficiently documented in routine care. Methods We compared clinical and immunological criteria in 366 children aged 0 to 12 years in Kinshasa and evaluated a simple computation to estimate CD4 percent, based on CD4 count, total white blood cell count and percentage lymphocytes. Kappa (κ) statistic was used to evaluate eligibility criteria and linear regression to determine trends of CD4 percent, count and total lymphocyte count (TLC). Results Agreement between clinical and immunological eligibility criteria was poor (κ = 0.26). One third of children clinically eligible for ART were ineligible using immunological criteria; one third of children immunologically eligible were ineligible using clinical criteria. Among children presenting in WHO stage I or II, 54 (32%) were eligible according to immunological criteria. Agreement with CD4 percent was poor for TLC (κ = 0.04), fair for total CD4 count (κ = 0.39) and substantial for CD4 percent computational estimate (κ = 0.71). Among 5 to 12 years old children, total CD4 count was higher in younger age groups (-32 cells/mm3 per year older), CD4 percent was similar across age groups. Conclusion Age-specific thresholds for CD4 percent optimally determine pediatric ART eligibility. The use of CD4 percent computational estimate may increase ART access in settings with limited access to CD4 percent assays.
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  • Article
Rights statement
  • In Copyright
Rights holder
  • Steven FJ Callens et al.; licensee BioMed Central Ltd.
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Journal title
  • BMC Infectious Diseases
Journal volume
  • 8
Journal issue
  • 1
Page start
  • 31
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1471-2334
Bibliographic citation
  • BMC Infectious Diseases. 2008 Mar 06;8(1):31
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • July 15, 2016

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