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Clinical and Diagnostic Laboratory Immunology, March 1999, p. 247-253, Vol. 6, No. 2
1071-412X/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Predictive Value of CD19 Measurements for Bacterial Infections in Children Infected with Human Immunodeficiency Virus

Rebecca A. Betensky,1,* Theresa Calvelli,2 and Savita Pahwa3

Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts 021151; Albert Einstein College of Medicine, Bronx, New York2; and North Shore University Hospital-New York University School of Medicine, Manhasset, New York 110303

Received 15 July 1998/Returned for modification 23 October 1998/Accepted 8 January 1999

We investigated the predictive value of CD19 cell percentages (CD19%) for times to bacterial infections, using data from six pediatric AIDS Clinical Trials Group protocols and adjusting for other potentially prognostic variables, such as CD4%, CD8%, immunoglobulin (IgA) level, lymphocyte count, prior infections, prior zidovudine treatment, and age. In addition, we explored the combined effects of CD19% and IgG level in predicting time to infection. We found that a low CD19% is associated with a nonsignificant 1.2-fold increase in hazard of bacterial infection (95% confidence interval: 0.97, 1.49). In contrast, a high IgG level is associated with a nonsignificant 0.87-fold decrease in hazard of infection (95% confidence interval: 0.68, 1.12). CD4% was more prognostic of time to bacterial infection than CD19% or IgG level. Low CD19% and high IgG levels together lead to a significant (P < 0.01) 0.50-fold decrease in hazard (95% confidence interval: 0.35, 0.73) relative to low CD19% and low IgG levels. Similarly, in a model involving assay result changes (from baseline to 6 months) as well as baseline values, the effect of CD19% by itself is reversed from its effect in conjunction with IgG. In this model, CD19% that are increasing and high are associated with decreases in hazard of infection (P < 0.01), while increasing CD19% and increasing IgG levels are associated with significant (at the P = 0.01 level) fourfold increases in hazard of infection relative to stable CD19% and decreasing, stable, or increasing IgG levels. Our data suggest that CD19%, in conjunction with IgG level, provides a useful prognostic tool for bacterial infections. It is highly likely that T-helper function impacts on B-cell function; thus, inclusion of CD4% in such analyses may greatly enhance the assessment of risk for bacterial infection.


* Corresponding author. Mailing address: Department of Biostatistics, Harvard School of Public Health, 655 Huntington Ave., Boston, MA 02115. Phone: (617) 432-2821. Fax: (617) 432-2832. E-mail: betensky{at}hsph.harvard.edu.


Clinical and Diagnostic Laboratory Immunology, March 1999, p. 247-253, Vol. 6, No. 2
1071-412X/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.






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Copyright © 1999 by the American Society for Microbiology. All rights reserved.