Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection

ABSTRACT

Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4⁺/CD8⁺ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4⁺/CD8⁺ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4⁺ cell count at inclusion, Nadir CD8⁺T-cell count, and Initial CD4⁺/CD8⁺ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4⁺/CD8⁺ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4⁺/CD8⁺ ratio > 1. The nadir CD4⁺T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4⁺/CD8⁺ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.

KEYWORDS
Human immunodeficiency virus; HIV-1; Early therapy; Antiretroviral therapy; cART; Non-HIV-associated diseases; CD4⁺/CD8⁺ ratio