Aging, trends in CD4+/CD8+ cell ratio, and clinical outcomes with persistent HIV suppression in a dynamic cohort of ambulatory HIV patients

Details

• Alternative Title:
  AIDS
• Personal Author:
  Novak, Richard M. ; Armon, Carl ; Battalora, Linda ; Buchacz, Kate ; Li, Jun ; Ward, Douglas ; Carlson, Kimberly ; Palella, Frank J.
• Corporate Authors:
  HIV Outpatient Study (HOPS) Investigators
• Description:
  Background:
  
  Age blunts CD4+ lymphocyte cell count/μl (CD4+) improvements observed with antiretroviral therapy (ART)-induced viral suppression among people with HIV (PWH). Prolonged viral suppression reduces immune dysregulation, reflected by rising CD4+/CD8+ ratios (CD4+/CD8+). We studied CD4+/CD8+ over time to determine whether it predicts risk for select comorbidities and mortality among aging PWH with viral suppression.
  
  Methods:
  
  We studied HIV Outpatient Study (HOPS) participants prescribed ART during 2000–2018 who achieved a viral load less than 200copies/ml on or after 1 January 2000, and remained virally suppressed at least 1 year thereafter. We modeled associations of CD4+/CD8+ with select incident comorbidities and all-cause mortality using Cox regression and controlling for demographic and clinical factors.
  
  Results:
  
  Of 2480 eligible participants, 1145 (46%) were aged less than 40 years, 835 (34%) 40–49 years, and 500 (20%) ≥ 50 years. At baseline, median CD4+/CD8+ was 0.53 (interquartile range: 0.30–0.84) and similar among all age groups (P = 0.18). CD4+/CD8+ values and percentage of participants with CD4+/CD8+ at least 0.70 increased within each age group (P < 0.001 for all). CD4+/CD8+ increase was greatest for PWH aged less than 40 years at baseline. In adjusted models, most recent CD4+/CD8+less than 1.00 and less than 0.70 were independently associated with higher risk of non-AIDS cancer and mortality, respectively.
  
  Conclusion:
  
  Pretreatment immune dysregulation may persist as indicated byCD4+/CD8+ less than 0.70. Persistent viral suppression can improve immune dysregulation over time, reducing comorbidity, and mortality risk. Monitoring CD4+/CD8+ among ART-treated PWH with lower values provide a means to assess for mortality and comorbidity risk.
  
  
• Subjects:
  Aging Anti-HIV Agents Antiretroviral Therapy, Highly Active CD4 Lymphocyte Count CD4-CD8 Ratio CD4-Positive T-Lymphocytes CD8-Positive T-Lymphocytes HIV Infections Humans Infant Viral Load

  More +
• Keywords:
  Cancer CD4+/CD8+ Ratio HIV Mortality Viral Suppression
• Source:
  AIDS. 36(6):815-827
• Pubmed ID:
  35013081
• Pubmed Central ID:
  PMC11004734
• Document Type:
  Journal Article
• Funding:
  75D30120C08752/CC/CDC HHSUnited States/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  36
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9b1778b3dc6767b7c5baec8fab6d2144a630aab5eba75bdd9c4e8b9eeebe4cee
• Download URL:
  https://stacks.cdc.gov/view/cdc/154160/cdc_154160_DS1.pdf
• File Type:
  [PDF - 1.59 MB ]