Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+

Hughes, Rachael A.; May, Margaret T; Tilling, Kate; Taylor, Ninon; Wittkop, Linda; Reiss, Peter; Gill, John; Schommers, Philipp; Costagliola, Dominique; Guest, Jodie L; Lima, Viviane D.; Monforte, Antonella d’Arminio; Smith, Colette; Cavassini, Matthias; Saag, Michael S.; Castilho, Jessica L; Sterne, Jonathan A C

doi:10.1097/qad.0000000000001848

Cited by 18 publications

(15 citation statements)

References 29 publications

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“…A recent study found that CD8 cell count trajectories, adjusted for baseline CD4 cell count but not for baseline CD8 cell count, were very similar for those starting ART with a CD4 count of ≥200 cells/mm 3 but long-term CD8 cell count trajectories were higher with lower baseline CD4 count when ART was started with counts <200 cells/mm 3 . 29 We show that reaching higher long-term CD8 cell counts is not only associated with lower baseline CD4 cell count but also with younger age and higher baseline CD8 cell count. CD8 cell counts at 8 years were lower with older age, similar, albeit at a higher value, compared to the trend in HIV-negative individuals.…”

Section: Discussionmentioning

confidence: 61%

“…25 In HIV-positive individuals, the ratio is decreased and low ratios are associated with pathological changes in the immune system such as immune activation, exhaustion, senescence, and memory abnormalities. 26–28 The ratio increases rapidly during the first few years on ART and keeps increasing up to 15 years after starting ART, albeit slowly, 29 and the ratio does not reach levels higher than 1.0 in two-thirds of individuals despite long-term viral suppression. 30,31…”

Section: Introductionmentioning

confidence: 99%

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Determinants of Restoration of CD4 and CD8 Cell Counts and Their Ratio in HIV-1–Positive Individuals With Sustained Virological Suppression on Antiretroviral Therapy

Gras¹,

May²,

Ryder³

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Determinants of Restoration of CD4 and CD8 Cell Counts and Their Ratio in HIV-1–Positive Individuals With Sustained Virological Suppression on Antiretroviral Therapy

Gras¹,

May²,

Ryder³

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…year 6 to 14) might be attributed to the continuous decrease in CD8+ T-cells as the CD4+ T-cell count in the same period plateaued. Previous report from HICs showed trends whereby the increase of CD4 counts and decrease of CD8 counts appeared to be similar [ 8 , 11 , 30 ]. Nonetheless, the trends to normalization time in the Ethiopian cohort appears to be much slower than those in HICs, similar to the cohort in Uganda [ 14 ].…”

Section: Discussionmentioning

confidence: 72%

Immune recovery in HIV-1 infected patients with sustained viral suppression under long-term antiretroviral therapy in Ethiopia

Wolday

Legesse²,

Kebede

et al. 2020

PLoS ONE

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Background There is very little data on long-term immune recovery responses in patients on suppressive antiretroviral therapy (ART) in the setting of sub-Saharan Africa (SSA). Thus, we sought to determine CD4+ T-cell, CD8+ T-cell and CD4/CD8 ratio responses in a cohort of HIV infected individuals on sustained suppressive ART followed up for more than a decade. Methods The cohort comprised adult patients who started ART between 2001 and 2007 and followed for up to 14 years. Trends in median CD4+ T-cells, CD8+ T-cells and CD4/CD8 ratio were reviewed retrospectively. Poisson regression models were used to identify factors associated with achieving normalized T-cell biomarkers. Kaplan-Meier curves were used to estimate the probability of attaining normalized counts while on suppressive ART. Results A total of 227 patients with a median duration of follow-up on ART of 12 (IQR: 10.5–13.0) years were included. CD4 cell count increased from baseline median of 138 cells (IQR: 70–202) to 555 cells (IQR: 417–830). CD4 cell increased continuously up until 5 years, after which it plateaued up until 14 years of follow up. Only 69.6% normalized their CD4 cell count within a median of 6.5 (IQR: 3.0–10.5) years. In addition, only 15.9% of the cohort were able to achieve the median reference CD4+ T-cell threshold count in Ethiopians (≈760 cells/μL). CD8+ T-cell counts increased initially until year 1, after which continuous decrease was ascertained. CD4/CD8 ratio trend revealed continuous increase throughout the course of ART, and increased from a median baseline of 0.14 (IQR: 0.09–0.22) to a median of 0.70 (IQR: 0.42–0.95). However, only 12.3% normalized their ratio (≥ 1.0) after a median of 11.5 years. In addition, only 8.8% of the cohort were able to achieve the median reference ratio of healthy Ethiopians. Conclusion Determination of both CD4+ and CD8+ T-cells, along with CD4/CD8 ratio is highly relevant in long-term follow-up of patients to assess immune recovery. Monitoring ratio levels may serve as a better biomarker risk for disease progression among patients on long-term ART. In addition, the findings emphasize the relevance of initiation of ART at the early stage of HIV-1 infection.

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“…Also we found initial low CD4 count, initial low CD4/CD8 ratio, shorter duration of ART and second-line ART increased the prevalence of CD4/CD8 ratio <0.30 in HIV/HBV patients. Evidence have shown that initial CD4 count can affect the ratio in HIV patients [46,[49][50][51]. Besides, 12% of HIV/HBV patients still receive CD4/CD8 ratio <0.30 after 34.5 months of ART.…”

Section: Discussionmentioning

confidence: 99%

The evaluation of antiretroviral treatment in HIV and hepatitis B virus (HBV) co-infected persons in Beijing, China, 2010-2018: a retrospective cohort study

Guo

Wang

et al. 2019

Preprint

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There is limited long-term data on the effect of ART on clinical outcomes in HIV/HBV patients in China. The objective of this study was to understand the ART treatment effect and the factors associated with the loss to follow-up or death of HIV/HBV co-infected patients in the city of Beijing, China. Methods: This study examined clinical indicators for HIV mono-infected or HIV/HBV co-infected patients from Jan. 2010 to Sep. 2018. Included patients were followed for a mean duration of 34.5 months after ART. Covariance analysis for repeated measures was used to analyze the changes of clinical indicators; multivariate logistic regression and Cox model were used to analyze the influencing factors of the abnormal incidence of clinical indicators and the lost to follow-up or death in HIV patients. Results: A total of 841 HIV/HBV co-infected patients and 2000 HIV patients were analyzed. Adherence was estimated to be 93% in all patients. At baseline, ALT, AST, OIs and APRI≥0.5 in HIV/HBV patients were higher, while the CD4 and CD4/CD8 ratio were lower. After ART treatment, the rate of APRI≥0.5 (4.4%) were still higher in HIV/HBV patients and HBV co-infection affect the prevalence of APRI≥0.5 (OR=2.745, 95% CI 1.041-7.243). The variables related to LTFU or death in HIV patients were initial CD4 (HR=0.784, 95% CI 0.652-0.943), APRI≥0.5 (HR=4.647, 95% CI 1.331-16.227), OIs (HR=4.910, 95% CI 2.352-10.247) and age (HR=1.336, 95% CI 1.004-1.778). HBV coinfection was not associated with increased LTFU or overall mortality in HIV patients (p>0.05). Conclusion: With good ART treatment and adherence rate, the clinical indicators were improved significantly in HIV/HBV co-infected patients. However, the incidence of hepatic fibrosis was higher in these patients.

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Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+

Abstract: Supplemental Digital Content is available in the text

Cited by 18 publications

References 29 publications

Determinants of Restoration of CD4 and CD8 Cell Counts and Their Ratio in HIV-1–Positive Individuals With Sustained Virological Suppression on Antiretroviral Therapy

Determinants of Restoration of CD4 and CD8 Cell Counts and Their Ratio in HIV-1–Positive Individuals With Sustained Virological Suppression on Antiretroviral Therapy

Immune recovery in HIV-1 infected patients with sustained viral suppression under long-term antiretroviral therapy in Ethiopia

The evaluation of antiretroviral treatment in HIV and hepatitis B virus (HBV) co-infected persons in Beijing, China, 2010-2018: a retrospective cohort study

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