AEGiS-14IAC: Low technology predictors of mortality for resource-poor settings: association of total lymphocyte count (TLC) and white blood cell count (WBC) with mortality in HIV-1-infected children.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Low technology predictors of mortality for resource-poor settings: association of total lymphocyte count (TLC) and white blood cell count (WBC) with mortality in HIV-1-infected children.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10171)

Mofenson LM, Harris DR, Moye J, Bethel J, Korelitz J, Nugent RN, Meyer W
PAMA/NICHD/NIH, Rockville, MD, United States

BACKGROUND: CD4 count and HIV RNA are useful for prognosis and to evaluate antiretroviral (ARV) response in resource-rich settings, but too complex and expensive for many resource-poor settings. We evaluated predictors of mortality applicable to such settings in HIV-infected children in the NICHD IVIG Clinical Trial, a cohort in which CD4 and RNA were shown previously to predict mortality (J Infect Dis 1997; 175:1029).

METHODS: TLC and WBC were measured at entry and q 3 mo on study.

RESULTS: Mean (SD) entry age and duration of follow-up were 40 (28) mo and 5.0 (2.9) yr, 92% of children were nonwhite, and 91% were perinatally-infected. At entry, no child was receiving ARV, mean CD4/ é L was 1127 (963) and mean log RNA copies/mL 5.02 (0.92). Of 376 children enrolled between 3/88-1/91and followed for vital status through 9/96, 148 (39%) died. Overall, mean entry TLC was 4241 and WBC 8300/ é L. Mean entry TLC and WBC were significantly lower (3392 vs 4788; p<0.001, and 7600 vs 8700; p=0.02) in children who died. Probability of death by entry TLC quartile (<2464; 2465-3641; 3642-5544; >5544) was 70, 34, 26 and 26% (p<0.001). For lowest vs other quartiles, relative risk (RR) of death was 2.4 (95% CI 1.9-3.0). Probability of death by entry WBC quartile (<5700; 5800-7900; 8000-10400; >10400) was 59, 33, 34, and 32% (p<0.002). For lowest vs other quartiles, RR of death was 1.8 (95% CI 1.4-2.3). Lowest vs other quartile mortality for RNA was 71 vs 31%, and for CD4%, 73 vs 25%. CD4 count had modest and better correlation with TLC (Pearson correlation [r] =0.49; p<0.001) and with WBC (r=0.32; p<0.001) than with RNA (r=0.12; p=0.06).

CONCLUSION: Low TLC and WBC are associated with increased mortality risk and could be used as criteria to initiate ARV for children in resource-poor settings. Further study is needed to determine if these surrogates can be used to monitor response to ARV.

Keywords: AEGIS, Lymphocyte Count, HIV-1, Leukocyte Count, CD4 Lymphocyte Count, HIV Infections, HIV Core Protein p24, HIV, Health Resources, HIV Antibodies, Poverty, Antigens, CD4, Anti-HIV Agents, HIV Protease Inhibitors, Child, Human, mortality, immunology

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B10171