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

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 cl...

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Detalles Bibliográficos
Autores: Prates, Gabriela da Silva, Monteiro, Mariana Amelia, Oliveira, Éricka Constantinov, Nascimento, Najara Ataide de Lima, Veiga, Ana Paula Rocha, Ferreira, Mauricio Domingues, Polis, Thales José Bueno, Caetano, Gabriela Prandi, Soares, Beatriz Rodrigues Pellegrina, Magri, Marcello Mihailenko Chaves, Pereira, Luisa Oliveira, Fonseca, Luiz Augusto Marcondes, Alves, Wagner Silva, Duarte, Alberto José da Silva, Casseb, Jorge Simão do Rosário
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:Brasil
Institución:Instituto de Medicina Tropical (IMT)
Repositorio:Revista do Instituto de Medicina Tropical de São Paulo
Idioma:inglés
OAI Identifier:oai:revistas.usp.br:article/221770
Acceso en línea:https://www.revistas.usp.br/rimtsp/article/view/221770
Access Level:acceso abierto
Palabra clave:Human immunodeficiency virus
HIV-1
Early therapy
Antiretroviral therapy
cART
Non-HIV-associated diseases
CD4 /CD8 ratio
Descripción
Sumario: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.

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