Abstract
Objective: Model trajectories of CD4+ and CD8+ cell counts after starting combination antiretroviral therapy (ART) and use the model to predict trends in these counts and the CD4+ : CD8+ ratio.
Design: Cohort study of antiretroviral-naïve HIV-positive adults who started ART after 1997 (ART Cohort Collaboration) with more than 6 months of follow-up data.
Methods: We jointly estimated CD4+ and CD8+ cell count trends and their correlation using a bivariate random effects model, with linear splines describing their population trends, and predicted the CD4+ : CD8+ ratio trend from this model. We assessed whether CD4+ and CD8+ cell count trends and the CD4+ : CD8+ ratio trend varied according to CD4+ cell count at start of ART (baseline), and, whether these trends differed in patients with and without virological failure more than 6 months after starting ART.
Results: A total of 39 979 patients were included (median follow-up was 53 months). Among patients with baseline CD4+ cell count at least 50 cells/µl, predicted mean CD8+ cell counts continued to decrease between 3 and 15 years post-ART, partly driving increases in the predicted mean CD4+ : CD8+ ratio. During 15 years of follow-up, normalization of the predicted mean CD4+ : CD8+ ratio (to >1) was only observed among patients with baseline CD4+ cell count at least 200 cells/µl. A higher baseline CD4+ cell count predicted a shorter time to normalization.
Conclusion: Declines in CD8+ cell count and increases in CD4+ : CD8+ ratio occurred up to 15 years after starting ART. The likelihood of normalization of the CD4+ : CD8+ ratio is strongly related to baseline CD4+ cell count.
Original language | English |
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Pages (from-to) | 1361-1367 |
Number of pages | 7 |
Journal | AIDS |
Volume | 32 |
Issue number | 10 |
Early online date | 19 Jun 2018 |
DOIs | |
Publication status | Published - 19 Jun 2018 |
Keywords
- CD4 : CD8 ratio
- CD4 cell count
- CD8 cell count
- combination antiretroviral therapy
- HIV
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Dr Rach Hughes
- Bristol Medical School (PHS) - Senior Research Fellow
- Bristol Population Health Science Institute
Person: Academic , Member