TY - JOUR
T1 - Immunologic risk factors for early mortality after starting antiretroviral therapy in HIV-Infected Zambian children
AU - Rainwater-Lovett, Kaitlin
AU - Nkamba, Hope C.
AU - Mubiana-Mbewe, Mwangelwa
AU - Moore, Carolyn Bolton
AU - Moss, William J.
PY - 2013/3/1
Y1 - 2013/3/1
N2 - To explore immunologic risk factors for death within 90 days of highly active antiretroviral therapy (HAART) initiation, CD4+ and CD8 + T cell subsets were measured by flow cytometry and characterized by logistic regression in 149 Zambian children between 9 months and 10 years of age enrolled in a prospective, observational study of the impact of HAART on measles immunity. Of 21 children who died during follow-up, 17 (81%) had known dates of death and 16 (76%) died within 90 days of initiating HAART. Young age and low weight-for-Age z-scores were associated with increased risks of mortality within 90 days of starting HAART, whereas CD4+ T cell percentage was not associated with mortality. After adjusting for these factors, each 10% increase in CD8+ effector T cells increased the odds of overall mortality [OR=1.43 (95% CI: 1.08, 1.90)] and was marginally associated with early mortality [OR=1.29 (95% CI: 0.97, 1.72)]. Conversely, each 10% increase in CD4+ central memory T cells decreased the odds of overall [OR=0.06 (95% CI: 0.01, 0.59)] and early mortality [OR=0.09 (95% CI: 0.01, 0.97)]. Logistic regression prediction models demonstrated areas under the receiver-operator characteristic curves of ≥85% for early and overall mortality, with bootstrapped sensitivities of 82-85% upon validation, supporting the predictive accuracy of the models. CD4+ and CD8+ T cell subsets may be more accurate predictors of early mortality than CD4 + T cell percentages and could be used to identify children who would benefit from more frequent clinical monitoring after initiating HAART.
AB - To explore immunologic risk factors for death within 90 days of highly active antiretroviral therapy (HAART) initiation, CD4+ and CD8 + T cell subsets were measured by flow cytometry and characterized by logistic regression in 149 Zambian children between 9 months and 10 years of age enrolled in a prospective, observational study of the impact of HAART on measles immunity. Of 21 children who died during follow-up, 17 (81%) had known dates of death and 16 (76%) died within 90 days of initiating HAART. Young age and low weight-for-Age z-scores were associated with increased risks of mortality within 90 days of starting HAART, whereas CD4+ T cell percentage was not associated with mortality. After adjusting for these factors, each 10% increase in CD8+ effector T cells increased the odds of overall mortality [OR=1.43 (95% CI: 1.08, 1.90)] and was marginally associated with early mortality [OR=1.29 (95% CI: 0.97, 1.72)]. Conversely, each 10% increase in CD4+ central memory T cells decreased the odds of overall [OR=0.06 (95% CI: 0.01, 0.59)] and early mortality [OR=0.09 (95% CI: 0.01, 0.97)]. Logistic regression prediction models demonstrated areas under the receiver-operator characteristic curves of ≥85% for early and overall mortality, with bootstrapped sensitivities of 82-85% upon validation, supporting the predictive accuracy of the models. CD4+ and CD8+ T cell subsets may be more accurate predictors of early mortality than CD4 + T cell percentages and could be used to identify children who would benefit from more frequent clinical monitoring after initiating HAART.
UR - http://www.scopus.com/inward/record.url?scp=84874457922&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874457922&partnerID=8YFLogxK
U2 - 10.1089/aid.2012.0246
DO - 10.1089/aid.2012.0246
M3 - Article
C2 - 23025633
AN - SCOPUS:84874457922
SN - 0889-2229
VL - 29
SP - 479
EP - 487
JO - AIDS research and human retroviruses
JF - AIDS research and human retroviruses
IS - 3
ER -