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Prognostic factors of a lower CD4/CD8 ratio in long term viral suppression HIV infected children

Sara Guillén1, Luis Prieto2, Santiago Jiménez de Ory3

  • 1Department Pediatrics, Hospital Universitario de Getafe, Madrid, Spain.

Plos One
|August 6, 2019
PubMed

Insights

Many children on combination antiretroviral therapy (cART) achieve viral suppression but not full immune recovery. Lower CD4 nadir and prior suboptimal therapy predict poorer immune recovery (CD4/CD8 ratio <1) in perinatally HIV-infected children.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Immunology

Background:

  • Combination antiretroviral therapy (cART) effectively suppresses viral load in children with HIV.
  • However, persistent immune activation can hinder complete immunological recovery in some children.
  • The CD4/CD8 ratio serves as a key marker for assessing immune reconstitution.

Purpose of the Study:

  • To identify prognostic factors associated with incomplete immune recovery in perinatally HIV-infected children on long-term cART.
  • To evaluate the CD4/CD8 ratio as a marker for immune reconstitution.
  • To determine clinical characteristics at cART initiation that predict a lower CD4/CD8 ratio.

Main Methods:

  • Retrospective analysis of 146 perinatally HIV-infected children with sustained viral suppression (>5 years) on first-line cART.
  • Logistic regression models were used to identify factors associated with a CD4/CD8 ratio <1 at the last visit.
  • Clinical data, including age at diagnosis and cART initiation, nadir CD4 count, and prior therapy, were analyzed.

Main Results:

  • 33% of children did not achieve a CD4/CD8 ratio >1.
  • Univariate analysis linked CD4/CD8 <1 to lower CD4 nadir, lower baseline CD4, older age at diagnosis/cART initiation, and prior mono-dual therapy.
  • Multivariate analysis confirmed associations between CD4/CD8 <1 and lower CD4 nadir (OR: 1.002) and prior mono-dual therapy (OR: 0.16).

Conclusions:

  • A significant proportion of children on long-term cART experience incomplete immune recovery, indicated by a CD4/CD8 ratio <1.
  • Lower CD4 nadir and prior exposure to suboptimal antiretroviral therapy are independent predictors of poorer immune recovery.
  • These findings highlight the importance of early and effective treatment to optimize long-term immune reconstitution in HIV-infected children.
Abstract

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