Prognostic markers
The most widely used surrogate markers for predicting disease progression in children, as in adults, are the CD4 values and viral load. Very high viral loads are frequently found in infected children, particularly following perinatal transmission (Figure 12.10).
Absolute CD4 counts are physiologically higher in children compared with adults (Figure 12.7). CD4 percentages vary rather less, and according to the CDC classification system can be used across all age ranges; >25% is considered evidence of no immunosuppression, 15—25% moderate and predictive values of each are low. Age-adjusted rates of change for viral load and CD4 counts may be of higher positive predictive value for disease progression: an analysis of combined European and US data is presently underway to evaluate this concept.
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