Absolute CD4+ T cell count overstate immune recovery assessed by CD4+/CD8+ ratio in HIV-infected patients on treatment

Guisado, Yusnelkis Milanés; Gutiérrez‐Valencia, Alicia; Trujillo‐Rodríguez, María; Espinosa, Núria; Viciana, Pompeyo; López‐Cortés, Luis F.

doi:10.1371/journal.pone.0205777

Cited by 17 publications

(11 citation statements)

References 32 publications

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“…Patients' clinical course is determined by the complex interplay between their immune and inflammatory status, even despite CD4 þ restoration: for this reason, we considered other markers of immune recovery, such as the CD4/CD8 and the CD4% normalization and the MTMR. Although both markers of immunity, variation of CD4 and CD4/CD8 are not necessarily correlated and may provide different information on immune restoration [37,38]. CD4/CD8 is candidate prognostic marker for comorbidities and mortality: low CD4/CD8 ratio is associated with higher risk of non-AIDS-related morbimortality despite long-term viral suppression [39][40][41].…”

Section: Discussionmentioning

confidence: 99%

Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment

Rava

Bisbal

Domínguez-Domínguez

et al. 2021

Aids

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Objectives: The aim of this study was to examine the impact of late presentation (CD4 þ cell count <350 cells/ml or an AIDS-defining event) on effectiveness and safety of initial antiretroviral therapy (ART) and to evaluate whether treatment response depends on first-line ART regimen in late presenters.Design: ART-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting triple ART between 2010 and 2018.Methods: We used multivariable models to assess differences in viral suppression (viral load <50 copies/ml), immunological response (change in CD4 þ cell count, CD4% (>29%) and CD4/CD8 normalization (>0.4 and >1) multiple T-cell marker recovery (MTMR): CD4 þ cell count more than 500 cells/ml and CD4% >29% and CD4/CD8 >1), and treatment discontinuation due to adverse events (TDAE) at 48 weeks from ART initiation.Results: Out of 8002 participants, 48.7% were late presenters. Of them, 45.8% initiated ART with a NNRTI-(mostly TDF/FTC/EFV), 33.9% with a protease inhibitor (mostly TDF/FTCþboosted DRV) and 20.3% with an INI-based regimen (mostly ABC/ 3TC/DTG). At 48 weeks, late presenters had similar viral suppression, but worse immunological response, than non-late presenters with no difference on TDAE. Late presenters initiating with NNRTI-based regimens were more likely to achieve viral suppression than those starting with INI-based, due to the higher chance of achieving viral suppression observed with TDF/FTC/RPV compared to ABC/3TC/DTG. Initial treatment with NNRTI or protease inhibitor based showed similar immunological response than the INI-based regimens, which showed lower rates of TDAE than NNRTIand protease inhibitor based regimens. Conclusion:Despite safety and effectiveness of initial ART in terms of viral suppression, late presenters may not experience complete immunological response. In late

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Section: Discussionmentioning

confidence: 99%

Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment

Rava

Bisbal

Domínguez-Domínguez

et al. 2021

Aids

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“…Studies show that even long-term antiretroviral treatment uncommonly leads to the normalization of CD4 count and CD4:CD8 ratio [ 11 , 12 ]. There are reports suggesting that CD4:CD8 ratio may better reflect immune dysfunction in well-controlled HIV infection than CD4+ cell count alone [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Clinical Biomarkers Related to CD4 Recovery in HIV-Infected Patients—5-Year Observation

Lembas

Załęski

Mikuła

et al. 2022

Viruses

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Human Immunodeficiency Virus infection leads to the impairment of immune system function. Even long-term antiretroviral therapy uncommonly leads to the normalization of CD4 count and CD4:CD8 ratio. The aim of this study was to evaluate possible clinical biomarkers which may be related to CD4 and CD4:CD8 ratio recovery among HIV-infected patients with long-term antiretroviral therapy. The study included 68 HIV-infected patients undergoing sustained antiretroviral treatment for a minimum of 5 years. Clinical biomarkers such as age, gender, advancement of HIV infection, coinfections, comorbidities and applied ART regimens were analyzed in relation to the rates of CD4 and CD4:CD8 increase and normalization rates. The results showed that higher rates of CD4 normalization are associated with younger age (p = 0.034), higher CD4 count (p = 0.034) and starting the therapy during acute HIV infection (p = 0.012). Higher rates of CD4:CD8 ratio normalization are correlated with higher CD4 cell count (p = 0.022), high HIV viral load (p = 0.006) and acute HIV infection (p = 0.013). We did not observe statistically significant differences in CD4 recovery depending on gender, HCV/HBV coinfections, comorbidities and opportunistic infections. The obtained results advocate for current recommendations of introducing antiretroviral therapy as soon as possible, preferably during acute HIV infection, since it increases the chances of sufficient immune reconstruction.

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“…We observed that the lower the CD4 / CD8 ratio, the higher the risk of septicemia for AIDS patients. After HIV enters the body, cd8 T cells will be more reactive before the cd4-T cells are reduced, resulting in a lower CD4 / CD8 ratio [1]. The replication of HIV virus in vivo leads to the decrease of CD4T cells and the decrease of CD4/CD8 ratio.…”

Section: Discussionmentioning

confidence: 99%

CD4/CD8 ratio can predict the risk of septicemia in HIV infection

ZHU¹,

Zheng²,

Chen³

et al. 2020

Preprint

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Objectives There are few reports about the effect of CD4/CD8 ratio on the infection of HIV with sepsis. Here we analyze the correlation between the baseline CD4 / CD8 ratio and the pathogenic spectrum of AIDS patients with sepsis and the effect on the prognosis. Methods A retrospective analysis study(May 2010 to June 2017) was carried out using routinely colleted data from HIV with spesis at Chengdu Public Health Clinical Center. The values of clinical data, CD4/CD8 ratio and pathogenic spectrum were evaluated in the study. Results Among 322 positive blood culture HIV patients with septicemia, 208 (64.60%) were fungal infection, 64 (19.90%) were gram-negative bacterial infection, 47 (14.60%) were Gram-positive bacterial infection, and 3 (0.90%) were fungal and bacterial infection. Among the fungal infections, Cryptococcus was found in 152 cases (73.08%), followed by cyanobacteria marneffei in 53 cases (25.48%) and Candida in 3 cases (1.44%); Salmonella in 38 cases (59.38%) and Escherichia coli in 17 cases (26.56%); Staphylococcus in 28 cases (59.58%) were positive. When the CD4 / CD8 ratio≤0.3, the risk of sepsis infection was significantly higher than that of CD4 / CD8 > 0.3. The lower the ratio of CD4 / CD8 (< 0.1), the higher the risk (χ 2 =188.968,P = 0.00).When the ratio of CD4 / CD8 was less than or equal to 0.3, the incidence of fungal infection was significantly increased (67.14%), and the incidence of gram-negative bacterial infection (18.02%) was significantly higher than that of Gram-positive bacterial infection (13.78%), (χ 2 = 283.277, P = 0.00); when the ratio of CD4 / CD8 was greater than or equal to 0.3, the incidence of septicemia was significantly reduced, and there was no significant difference between the original spectrum of infection (χ 2 = 1.750, P=0.42)。 286 patients (88.82%) were discharged after treatment, 36 patients (11.18%) died after treatment. Conclusions In Chengdu of China, the main pathogens of septicemia in AIDS patients are fungi, including Cryptococcus and cyanobacteria marneffei, next are bacteria containing Salmonella and Staphylococcus. The lower the ratio of CD4 / CD8, the higher the risk of infection with sepsis, the higher the risk of multiple infection, and the higher the mortality. Therefore, we think that CD4 / CD8 ratio is an important risk factor for HIV infection with septicemia. We should pay more attention to role of the CD4 / CD8 ratio in clinical work, and it may be help us predicting progress of HIV disease.

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Absolute CD4+ T cell count overstate immune recovery assessed by CD4+/CD8+ ratio in HIV-infected patients on treatment

Cited by 17 publications

References 32 publications

Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment

Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment

Evaluation of Clinical Biomarkers Related to CD4 Recovery in HIV-Infected Patients—5-Year Observation

CD4/CD8 ratio can predict the risk of septicemia in HIV infection

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