CD4 status and P24 antigenemia. Are they useful predictors of survival in HIV-infected children receiving antiretroviral therapy?
K. M. Butler, R. N. Husson, L. L. Lewis, B. U. Mueller, D. Venzon and P. A. Pizzo
Pediatric Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892.
OBJECTIVE--To determine the relationship between CD4 status and the P24
antigen level and survival in children infected with the human
immunodeficiency virus. DESIGN--Cohort, case-control. SETTING--Clinical
Center at the National Institutes of Health, Bethesda, Md.
PARTICIPANTS--One hundred forty-seven children infected with the human
immunodeficiency virus enrolled in antiretroviral therapy protocols at the
National Cancer Institute were reviewed and the relationships between CD4
counts, P24 antigenemia, and death were analyzed. INTERVENTIONS--None.
MEASUREMENTS/MAIN RESULTS--The presence of a very low CD count, less than
21% of the lower limit of normal values for age (equivalent to 0.05 x
10(9)/L in an adult), was associated with a significantly increased risk of
death within 2 years. Although the risk of death was highest for children
with CD4 counts below this level and who had detectable P24 antigen levels,
P24 antigenemia by itself contributed little to the prognostic value of the
CD4 count alone. However, it was also notable that a group of children with
low CD4 counts also experienced prolonged survival. CONCLUSIONS--The
association between low CD4 counts and death suggests that the age-adjusted
CD4 count should be used as a marker to guide therapeutic intervention. At
the same time, the presence of a very low CD4 count alone should not be
considered a reason for therapeutic nihilism.
