CD4 cell count criteria to determine when to initiate antiretroviral therapy in human immunodeficiency virus-infected children.

Wongsawat, Jurai; Puthanakit, Thanyawee; Kanjanavanit, Suparat; Hansudewechakul, Rawiwan; Ngampiyaskul, Chaiwat; Kerr, Stephen J; Ubolyam, Sasiwimol; Suwanlerk, Tulathip; Kosalaraksa, Pope; Luesomboon, Wicharn; Ngo-Giang-Huong, Nicole; Chandara, Mom; Saphonn, Vonthanak; Ruxrungtham, Kiat; Ananworanich, Jintanat

We evaluated the validity of CD4 count against CD4% criteria of 2008 World Health Organization guideline for initiating antiretroviral therapy using the data of 446 human immunodeficiency virus-infected Asian children aged 1 to 12 years who were screened to the Pediatric Randomized of Early versus Deferred Initiation in Cambodia and Thailand study. The overall sensitivity and specificity were 34% and 98%, respectively. Using the current CD4 count criteria would globally result in 66% missed opportunity to initiate treatment in a timely fashion. Raising CD4 count thresholds should be considered to increase its sensitivity and reduce missed opportunity.