CD4/CD8 Ratio During Human Immunodeficiency Virus Treatment: Time for Routine Monitoring?

Abstract

In the last decade, studies in PWH on ART have shed light on the significance of persistently high CD8 counts and low CD4/CD8 ratios. A low CD4/CD8 ratio translates increased immune activation and is associated with an increased risk of severe non-AIDS events. As a result, many clinicians now believe that the CD4/CD8 ratio can help in HIV monitoring, and many researchers now report it as an efficacy marker in interventional studies. However, the topic is more complex. Recent studies have not yielded unanimous conclusions on the ability of CD4/CD8 ratio to predict adverse outcomes, and only some clinical guidelines recommend monitoring it. Knowledge gaps remain on the best cut-off points, associated clinical events, effects of treatments, and how CD4/CD8 ratio could improve decision-making in the clinic. Here, we critically review the literature, identify knowledge gaps and discuss the role of the CD4/CD8 ratio as a marker for HIV monitoring.

Expanding HIV Clinical Monitoring: The Role of CD4, CD8, and CD4/CD8 Ratio in Predicting Non-AIDS Events

“…In addition, we used a robust definition of SNAEs, which were prospectively adjudicated in CoRIS. Specifically, we included MACEs and NADMs, as these are the SNAEs that have demonstrated a more consistent association with the CD4/CD8 ratio in prior research [7,[9][10][11][12]25].…”

“…The CD4/CD8 ratio has emerged as a useful indicator of immune dysfunction in PWH. It can be easily monitored in routine clinical practice and correlates with markers of immunosenescence and inflammation, which are technically difficult to measure and too variable to be used at an individual level [6,7]. PWH with a low CD4/CD8 ratio exhibit increased inflammation and immunosenescence despite successful ART (i.e., having achieved a CD4 count >500 cells/μL) [8].…”

“…However, results are conflicting, with variations in study designs, timing of ratio measurement, ratio thresholds, and endpoints. While some studies have found a significant association between a low CD4/CD8 ratio and an increased risk of SNAEs or mortality [7][8][9][10][11][12], others have failed to find this association [14,15]. This lack of consensus has led to discrepancies in clinical guidelines regarding the appropriateness of monitoring the CD4/CD8 ratio [16,17].…”

The role of inflammatory factors and T‐cell subsets in the diagnosis of recurrence in epithelial ovarian cancer patients and the effect of olaparin treatment on them

“…The decrease of the CD4 + /CD8 + ratio is an important feature of immune deficiency disease 20 . The T‐lymphocyte subsets in the peripheral blood of tumor patients were abnormal, including the significant decrease of CD3 + and CD4 + T cells, the significant increase of CD8 + T cells, and the significant decrease of the CD4 + /CD8 + ratio 18 .…”

“…At present, more and more studies show that T‐lymphocyte subsets have abnormal changes in ovarian cancer 18 and different T lymphocytes have an important impact on the ovarian cancer development 19 . The decrease of CD4 + /CD8 + ratio is an important feature of immune deficiency disease 20 . Serum human epididymis secretory protein‐4 (HE4) is one of the most sensitive tumor markers of ovarian cancer found in recent years.…”