CD4/CD8 ratio restoration low, associated with early treatment

Only half of HIV-infected patients who received combined ART for at least 2 years achieved adequate CD4/CD8 ratios, according to data presented at the European AIDS Conference.

“Despite combined antiretroviral therapy, the CD4/CD8 ratio may remain inverted (< 1) in a majority of HIV-infected individuals,” Fabienne Caby, MD, of Hôpital Pitié-Salpêtrière in Paris, and colleagues, wrote. “This profile has been shown to be associated with a higher risk of non-AIDS morbidity and mortality.”

Caby and colleagues examined data on 10,149 patients with HIV from the French Hospital Database on HIV to determine the probability of CD4/CD8 ratio restoration (≥ 1) after years of ART. Patients began combined therapy between 2000 and 2010 and received treatment for at least 2 years. Virological control, defined as less than 500 copies/mL before 2006 and 50 copies/mL thereafter, was attained within 9 months of treatment. The researchers used Kaplan-Meier values to estimate the probability of ratio restoration, and Cox regression models to search for associated factors.

The probability of ratio restoration was 52% (95% CI, 51-53) up to 8 years after therapy, according to the data. The percentage decreased to 36% (95% CI, 35-38) in patients with an AIDS-related event at ART initiation, and increased to 81% (95% CI, 74-88) in patients with primary HIV infection, regardless of CD4 count at ART initiation (HR = 3.43; 95% CI, 2.72-4.32).

Patients who started therapy with a minimum CD4 count of 500/mm³ were more likely to have CD4/CD8 restoration (HR = 2.78; 95% CI, 2.45-3.15) compared with patients who had a CD4 count between 200/mm³ and 349/mm³. Ratio restoration was also more common in patients who started therapy between 2009 and 2010 vs. 2000 and 2002 (HR = 2.4; 95% CI, 2.1-2.74), and in those who achieved virological control faster (HR = 5.08; 95% CI, 4.13-6.24 per 1-month decrease). Those with higher CD8 counts at ART introduction were less likely to achieve restoration, according to the researchers.

“Early diagnosis and treatment appear to be the key to improve this ratio as well as a faster virological control,” Caby and colleagues concluded. – by Stephanie Viguers

Reference:

Caby F, et al. Abstract 898. Presented at: the European AIDS Conference; Oct. 21-24, 2015; Barcelona, Spain.

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