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Clinical and Diagnostic Laboratory Immunology, March 1999, p. 247-253, Vol. 6, No. 2
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.
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
*
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.
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