Comparison of CD4 Cell Count, Viral Load, and Other Markers for the Prediction of Mortality among HIV-1–Infected Kenyan Pregnant Women

Citation:
Elizabeth R. Brown, Phelgona Otieno, Dorothy A. Mbori-Ngacha, Carey Farquhar, Elizabeth M. Obimbo, Ruth Nduati JO. "Comparison of CD4 Cell Count, Viral Load, and Other Markers for the Prediction of Mortality among HIV-1–Infected Kenyan Pregnant Women." J Infect Dis. 2009 May 1; . 2009;199(9): 1292–1300. doi:10.1086/597617.

Abstract:

Abstract
Background—There are limited data regarding the relative merits of biomarkers as predictors of
mortality or time to initiation of antiretroviral therapy (ART).
Methods—We evaluated the usefulness of the CD4 cell count, CD4 cell percentage (CD4%), human
immunodeficiency virus type 1 (HIV-1) load, total lymphocyte count (TLC), body mass index (BMI),
and hemoglobin measured at 32 weeks’ gestation as predictors of mortality in a cohort of HIV-1–
infected women in Nairobi, Kenya. Sensitivity, specificity, positive predictive value (PPV), and area
under the receiver operating characteristic (ROC) curve (AUC) were determined for each biomarker
separately, as well as for the CD4 cell count and the HIV-1 load combined.
Results—Among 489 women with 10,150 person-months of follow-up, mortality rates at 1 and 2
years postpartum were 2.1% (95% confidence interval [CI], 0.7%–3.4%) and 5.5% (95% CI, 3.0%–
8.0%), respectively. CD4 cell count and CD4% had the highest AUC value (>0.9). BMI, TLC, and
hemoglobin were each associated with but poorly predictive of mortality (PPV, <7%). The HIV-1
load did not predict mortality beyond the CD4 cell count.
Conclusions—The CD4 cell count and CD4% measured during pregnancy were both useful
predictors of mortality among pregnant women. TLC, BMI, and hemoglobin had a limited predictive
value, and the HIV-1 load did not predict mortality any better than did the CD4 cell count alone.
In 2007, >85% of the world’s estimated 2 million HIV-infected pregnant women lived in sub-
Saharan Africa [1]. Many women in this region have HIV-1 infection diagnosed during
pregnancy as part of programs designed to prevent mother-to-child transmission of HIV-1
(PMTCT). Within these programs for the prevention of mother-to-child transmission of HIV-1,

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