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Increased CD4 : CD8 ratio normalization with implementation of current ART management guidelines.

Alice Zhabokritsky1,2, Leah Szadkowski1,3, Curtis Cooper4,5

  • 1Department of Medicine, University Health Network, Toronto, Canada.

The Journal of Antimicrobial Chemotherapy
|November 29, 2020
PubMed
Summary
This summary is machine-generated.

Higher baseline CD4+ T-cell counts significantly impact CD4:CD8 ratio normalization in adults with HIV on modern antiretroviral therapy (ART). Early ART initiation is key for immune recovery.

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Area of Science:

  • Immunology
  • Virology
  • Public Health

Background:

  • The CD4:CD8 ratio is a marker of immune system health, often altered in individuals with HIV.
  • Modern antiretroviral therapy (ART) has transformed HIV management, but immune reconstitution varies.
  • Understanding factors influencing CD4:CD8 ratio normalization is crucial for optimizing HIV care.

Purpose of the Study:

  • To determine the time to CD4:CD8 ratio normalization in Canadian adults with HIV receiving ART.
  • To identify patient characteristics associated with achieving a normalized CD4:CD8 ratio (≥1.0).

Main Methods:

  • Retrospective analysis of the Canadian Observational Cohort (CANOC) including ART-naive adults initiating ART between 2011-2016.
  • Participants had a baseline CD4:CD8 ratio <1.0 and at least two follow-up measurements.
  • Kaplan-Meier estimates and proportional hazards models were used to analyze time to normalization and associated factors.

Main Results:

  • Of 3218 participants, 28% achieved normalization over a median of 2.6 years.
  • Higher baseline CD4+ T-cell counts were strongly associated with faster normalization (P<0.0001).
  • The probability of normalization by 5 years was significantly higher for those with baseline CD4+ T-cell counts >500 cells/mm3 compared to ≤200 cells/mm3.

Conclusions:

  • Early initiation of ART, particularly with higher baseline CD4+ T-cell counts, maximizes the chances of CD4:CD8 ratio normalization.
  • The study supports current guidelines recommending immediate ART initiation.
  • No significant difference in ratio normalization was observed based on the class of ART used.