Open Access Research

T lymphocytes among HIV-infected and -uninfected infants: CD4/CD8 ratio as a potential tool in diagnosis of infection in infants under the age of 2 years

Lynn S Zijenah1*, David A Katzenstein2, Kusum J Nathoo3, Simbarashe Rusakaniko4, Ocean Tobaiwa1, Christine Gwanzura5, Arsene Bikoue67, Margaret Nhembe3, Petronella Matibe3 and George Janossy6

Author Affiliations

1 Department of Immunology, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe

2 Division of Infectious Diseases and AIDS Research, Stanford University Medical School, Stanford, California, USA

3 Department of Paediatrics, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe

4 Department of Community Medicine, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe

5 Department of Haematology, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe

6 Department of Immunology and Molecular Pathology, Royal Free and University College Medical School, London, UK

7 Department of Flow Cytometry, MFN International, Asmara, Eritrea

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Journal of Translational Medicine 2005, 3:6  doi:10.1186/1479-5876-3-6

Published: 1 February 2005

Abstract

Background

Serologic tests for HIV infection in infants less than 18 months do not differentiate exposure and infection since maternally acquired IgG antibodies may be detected in infants. Thus, the gold standard for diagnosis of HIV-1 infection in infants under the age of 2 years is DNA or reverse transcriptase polymerase chain reaction. There is an urgent need to evaluate alternative and cost effective laboratory methods for early diagnosis of infant HIV-1 infection as well as identifying infected infants who may benefit from cotrimoxazole prophylaxis and/or initiation of highly active antiretroviral therapy.

Methods

Whole blood was collected in EDTA from 137 infants aged 0 to 18 months. DNA polymerase chain reaction was used as the reference standard for diagnosis of HIV-1 infection. T-cell subset profiles were determined by flow cytometry.

Results

Seventy-six infants were DNA PCR positive while 61 were negative. The median CD4 counts of PCR negative infants were significantly higher than those of the PCR positive infants, p < 0.001. The median CD4/CD8 ratio and the %CD4 of the PCR positive infants were both significantly lower than those of the negative infants, p < 0.001. The CD4/CD8 ratio had a >98% sensitivity for diagnosis of HIV-1 infection and a specificity of >98%.

Conclusion

The CD4/CD8 ratio appears useful in identifying HIV-infected infants. The development of lower cost and more robust flow cytometric methods that provide both CD4/CD8 ratio and %CD4 may be cost-effective for HIV-1 diagnosis and identification of infants for cotrimoxazole prophylaxis and/or highly active antiretroviral therapy.