CD4/CD8 ratio, comorbidities, and aging in treated HIV infected individuals on viral suppression

Abstract

The progression of the human immunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome (AIDS) can be efficiently interrupted by antiretroviral therapy (ART). However, even successfully treated HIV‐infected individuals are prone to develop non‐AIDS‐related diseases that affect the metabolism and several organs and systems. Biomarkers that predict the occurrence of comorbidities may help develop preventive measures. Current research shows that CD4+ T cell counts and viral load do not predict the development of non‐AIDS‐related diseases. The CD4/CD8 ratio has been indicated as a suitable marker of persistent immune dysfunction and the occurrence of non‐AIDS‐related events in treated HIV‐positive patients. In this study, we explored the relationship between CD4/CD8 ratios, comorbidities, and aging in ART‐treated HIV patients on viral suppression. We collected and evaluated data from 352 HIV‐positive adults who were virologically suppressed (<40 copies/mL) on ART and with CD4 counts above 350 cells/mm3. The median age for participants was 46 years, 218 individuals had at least one comorbidity, and 239 had inverted CD4/CD8 ratios (<1). Current CD4/CD8 ratios were predicted by baseline CD4/CD8 ratios and nadir CD4 counts. Despite the high rates of inverted CD4/CD8 ratios and prevalence of comorbidities, no association between them was observed. The prevalence of comorbidities was significantly higher in older individuals, though aging alone did not explain the rate of all individual comorbidities. Low CD4/CD8 ratios were linked to neurocognitive disorders, suggesting that persistent T cell dysfunction contributes to neurocognitive decline.

Perfil dos usuários vivendo com HIV/Aids atendidos em um Centro de Testagem e Aconselhamento no interior da Bahia: um estudo longitudinal retrospectivo

“…Verificou-se que os níveis de linfócitos T CD8 + estavam diretamente relacionados a carga viral e isso deve-se ao importante papel dessas células no combate às infecções causadas por vírus. Portanto, na tentativa de eliminar o vírus, quanto maior a carga viral, maiores serão os níveis detectados dessas células 1,25 . As células T CD4 + , por sua vez, apresentaram uma relação inversamente proporcional com a carga viral, o que pode ser justificada pela história natural da infecção pelo HIV, na qual esses linfócitos são os principais alvos da infecção pelo vírus 1,13 .…”

“…Tal fato pode ser evidenciado pelo presente trabalho, em que diferenças laboratoriais significativas foram identificadas entre os níveis de linfócitos T CD8 + e T CD45 + na abordagem por sexo. De acordo com o estudo realizado na província chinesa, Yunnan, a partir da análise da contagem de células por sexo, a média dos valores absolutos de linfócitos T CD4 + e linfócitos T CD45 + foram maiores nas mulheres do que nos homens vivendo com HIV/Aids 25,27 . A literatura sobre o comportamento imunológico do HIV entre os diferentes sexos ainda não está totalmente esclarecida.…”

“…Em relação à razão de linfócitos T CD4 + /CD8 + entre os indivíduos estudados, percebe-se que ela esteve abaixo de um na maioria dos casos. De acordo com Passos et al (2020) 25 , a menor razão (ou < 1) entre linfócitos T CD4 + /CD8 + é um indicador de disfunção imunológica persistente e seria resultante de uma expansão continuada de novos linfócitos T CD8 + altamente especializados e senescentes que levariam a um ritmo retardado de recuperação do número de linfócitos T CD4 + e T CD8 + virgens e piora dos estágios de imunossupressão. Assim, embora a ausência de linfócitos T CD4 + cause prejuízo funcional, a expansão dos linfócitos T CD8 + seria mais importante na relação linfócitos T CD4 + /CD8 +25 .…”

Pre-Digested Protein Enteral Nutritional Supplementation Enhances Recovery of CD4+ T Cells and Repair of Intestinal Barrier in HIV-Infected Immunological Non-Responders

“…This study also found that CD8 + T cells in the peripheral blood of patients with poor immune reconstitution remained elevated after nutritional treatment, which may be the result of persistent immune activation and inflammatory response caused by microbial translocation (31). In addition, CD8 + T cell counts increased, possibly because CD8 + T cells responded to both viral and intestinal CD4 + T cell depletion, and low CD4/CD8 ratio (< 1), which was not altered by nutritional intervention, promoted an increase in CD8 + T cell counts (32).…”

HIV-related non-Hodgkin lymphomas affecting the oral cavity: a clinicopathologic study of 11 cases

“…The human immunodeficiency virus (HIV) was initially identified in the 1980s in five young men affected by Pneumocystis carinii pneumonia and other opportunistic infections ( 1 ). HIV infection triggers an important immunosuppression condition by disrupting CD4+ T lymphocytes function, leading to a higher risk of developing opportunistic diseases ( 2 , 3 ), especially when CD4+ T cell count falls below than 200 cells/mm3, when the diagnosis of Acquired Immunodeficiency Syndrome (AIDS) is established ( 3 , 4 ).…”