Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection

Author(s):Show less -

Gabriela da Silva Prates ^[1] ; Mariana Amelia Monteiro ; Éricka Constantinov Oliveira ^[3] ; Najara Ataide de Lima Nascimento ; Ana Paula Rocha Veiga ^[5] ; Mauricio Domingues Ferreira ^[6] ; Thales José Bueno Polis ^[7] ; Gabriela Prandi Caetano ^[8] ; Beatriz Rodrigues Pellegrina Soares ^[9] ; Marcello Mihailenko Chaves Magri ^[10] ; Luisa Oliveira Pereira ; Luiz Augusto Marcondes Fonseca ^[12] ; Wagner Silva Alves ^[13] ; Alberto José da Silva Duarte ^[14] ; Jorge Simão do Rosário Casseb

Affiliation:Show less -

^[1] Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical de São Paulo - Brasil

^[3] Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical de São Paulo - Brasil

^[5] Universidade de São Paulo. Hospital das Clínicas. Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias - Brasil

^[6] Universidade de São Paulo. Hospital das Clínicas. Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias - Brasil

^[7] Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical de São Paulo - Brasil

^[8] Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical de São Paulo - Brasil

^[9] Universidade de São Paulo. Hospital das Clínicas. Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias - Brasil

^[10] Universidade de São Paulo. Hospital das Clínicas. Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias - Brasil

^[12] Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical de São Paulo - Brasil

^[13] Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical de São Paulo - Brasil

^[14] Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical de São Paulo - Brasil

• Document type: Journal article
• Source: Revista do Instituto de Medicina Tropical de São Paulo; v. 66, 2024-02-05.

Abstract

ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors. (AU)

• FAPESP's process: 14/22827-7 - Prevalence and incidence of early central nervous system disturbance in HTLV-1-infected subjects in Brazil
• Grantee: Jorge Simao do Rosario Casseb
• Support Opportunities: Regular Research Grants