CD4/CD8 ratio normalisation and non-AIDS-related events in individuals with HIV who achieve viral load suppression with antiretroviral therapy: an observational cohort study

CD4 and CD4/CD8 ratio progression in HIV-HCV infected patients after achievement of SVR

“…The CD4/CD8 ratio is known to be associated with the chronic inflammation state of HIV-infected patients [28] and linked to the probability of occurrence of non-AIDS events [29]. In a previous paper [30], we observed that even in patients with an extensive history of HIV infection (more than 15 years) less than 40% of patients normalize the CD4/CD8 ratio, despite a good recovery of the CD4 cell count.…”

CD4:CD8 Ratio and Non AIDS Defining Events in Virally Suppressed HIV Infected Patients: Need to Look Beyond CD4+ T cell Counts

“…Fewer than 15% in an Italian cohort, attained a normal CD4:CD8 ratio after reaching an undetectable viral load with Antiretroviral therapy (ART). 1 The estimated probability of normalization was 4.4% at 1 year, 11.5% at 2 years, and 29.4% at 5 years of ART initiation among those whose CD4:CD8 ratio normalized after ART initiation. Median time to a normal ratio was reported to be 10.1 years.…”

“…Median time to a normal ratio was reported to be 10.1 years. 1,19,20 Factors described to be associated with normalization include high CD4:CD8 ratio at ART initiation, high pre ART CD4 and negative cytomegalovirus cytology. Those less likely to achieve normalization were older, route of HIV transmission was through homosexual contact or intravenous drug use, longer interval between ART initiation and first viral suppression and more likely to have been treated with zidoviduine and lamivudine, didanosine and stavudine as compared to emtricitabine and tenofovir.…”

“…Those less likely to achieve normalization were older, route of HIV transmission was through homosexual contact or intravenous drug use, longer interval between ART initiation and first viral suppression and more likely to have been treated with zidoviduine and lamivudine, didanosine and stavudine as compared to emtricitabine and tenofovir. 1,12,19,20 Tenofovir and emtricitabine which have lesser toxicity on bone marrow could contribute to early normalization of the ratio. 1 Moreover positive correlation of higher CD4 count at ART initiation with CD4:CD8 recovery supports early initiation of ART.…”

“…1,12,19,20 Tenofovir and emtricitabine which have lesser toxicity on bone marrow could contribute to early normalization of the ratio. 1 Moreover positive correlation of higher CD4 count at ART initiation with CD4:CD8 recovery supports early initiation of ART. Early ART initiation may contribute to more rapid and robust CD4:CD8 ratio normalization, and the ratio may be a useful clinical endpoint to be used in evaluating novel therapies for ongoing immune dysfunction during treated infection and for HIV eradication.…”