Quantification of human immunodeficiency virus type 1 p24 antigen and antibody rivals human immunodeficiency virus type 1 RNA and CD4(+) enumeration for prognosis
Js. Read et al., Quantification of human immunodeficiency virus type 1 p24 antigen and antibody rivals human immunodeficiency virus type 1 RNA and CD4(+) enumeration for prognosis, PEDIAT INF, 19(6), 2000, pp. 544-551
Background. The sensitivity, specificity and positive predictive value of b
aseline serum concentrations of HIV-1 immune complex-dissociated (ICD) p24
antigen for predicting disease progression and mortality were assessed and
compared with results obtained for HIV-1 ICD p24 antigen with HIV-1 p24 ant
ibody and for HIV-1 RNA with CD4(+) lymphocyte percent.
Methods. Data from HIV-infected children enrolled in a North American clini
cal trial (National Institute of Child Health and Human Development Intrave
nous Immunoglobulin Clinical Trial) were analyzed. Disease progression was
defined as growth failure, CD4(+) lymphocyte percent decline to <15% after
study entry or development of an AIDS-defining opportunistic infection.
Results. Baseline samples were available for ICD p24 antigen testing (media
n concentration, 319 pg/ml; range, <50 to 15 640) in 240 children. The comb
ination of detectable ICD p24 antigen and low p24 antibody was more sensiti
ve but less specific than the combination of high HIV-1 RNA and low CD4(+)
lymphocyte percent in predicting disease progression and mortality. Using r
eceiver operating characteristic curves, the specificity of ICD p24 antigen
with p24 antibody for classifying children's disease progression or mortal
ity was as great as, or greater than, HIV-1 RNA with CD4(+) lymphocyte perc
ent at points on the curve corresponding to higher sensitivity,
Conclusions, The use of ICD p24 antigen with p24 antibody to identify child
ren at high risk of disease progression or mortality could be a viable alte
rnative to the more expensive and technically difficult HIV-1 RNA and CD4() lymphocyte assays in resource-poor settings, including developing countri
es where the majority of children with HIV-1 infection reside.