Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+:CD8+ ratioCD8+ ratio

Rachael A. Hughes*, Margaret T. May, Kate Tilling, Ninon Taylor, Linda Wittkop, Peter Reiss, John Gill, Philipp Schommers, Dominique Costagliola, Jodie L. Guest, Viviane D. Lima, Antonella D'Arminio Monforte, Colette Smith, Matthias Cavassini, Michael Saag, Jessica L. Castilho, Jonathan A.C. Sterne

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

5 Citations (Scopus)
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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 languageEnglish
Pages (from-to)1361-1367
Number of pages7
JournalAIDS
Volume32
Issue number10
Early online date19 Jun 2018
DOIs
Publication statusPublished - 19 Jun 2018

Keywords

  • CD4 : CD8 ratio
  • CD4 cell count
  • CD8 cell count
  • combination antiretroviral therapy
  • HIV

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    Hughes, R. A., May, M. T., Tilling, K., Taylor, N., Wittkop, L., Reiss, P., Gill, J., Schommers, P., Costagliola, D., Guest, J. L., Lima, V. D., D'Arminio Monforte, A., Smith, C., Cavassini, M., Saag, M., Castilho, J. L., & Sterne, J. A. C. (2018). Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+:CD8+ ratioCD8+ ratio. AIDS, 32(10), 1361-1367. https://doi.org/10.1097/QAD.0000000000001848