Abstract
BACKGROUND: An increasing number of HIV-positive individuals now start antiretroviral therapy (ART) with high CD4 cell counts. We investigated whether this makes restoration of CD4 and CD8 cell counts and the CD4:CD8 ratio during virologically suppressive ART to median levels seen in HIV-uninfected individuals more likely and whether restoration depends on gender, age, and other individual characteristics.
METHODS: We determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2309 HIV-negative individuals. We used longitudinal measurements of 60,997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models.
RESULTS: When baseline CD4 cell counts were higher, higher long-term CD4 cell counts and CD4:CD8 ratios were reached. Highest long-term CD4 cell counts were observed in middle-aged individuals. During the first 2 years, median CD8 cell counts converged toward median reference values. However, changes were small thereafter and long-term CD8 cell count levels were higher than median reference values. Median 8-year CD8 cell counts were higher when ART was started with <250 CD4 cells/mm. Median CD4:CD8 trajectories did not reach median reference values, even when ART was started at 500 cells/mm.
DISCUSSION: Starting ART with a CD4 cell count of ≥500 cells/mm makes reaching median reference CD4 cell counts more likely. However, median CD4:CD8 ratio trajectories remained below the median levels of HIV-negative individuals because of persisting high CD8 cell counts. To what extent these subnormal immunological responses affect specific clinical endpoints requires further investigation.
Original language | English |
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Pages (from-to) | 292-300 |
Number of pages | 9 |
Journal | Journal of Acquired Immune Deficiency Syndromes |
Volume | 80 |
Issue number | 3 |
Early online date | 1 Mar 2019 |
DOIs | |
Publication status | Published - Mar 2019 |
Keywords
- CD4 cell count
- CD8 cell count
- CD4:CD8 ratio
- antiretroviral therapy
- HIV
- age
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Profiles
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Professor Jonathan A C Sterne
- Bristol Medical School (PHS) - Professor of Medical Statistics and Epidemiology
- Bristol Population Health Science Institute
- NIHR Applied Research Collaboration West (NIHR ARC West)
- Infection and Immunity
Person: Academic , Member