Related Experiment Video
Updated: Aug 8, 2025
Chronic, Acute, and Reactivated HIV Infection in Humanized Immunodeficient Mouse Models
Published on: December 3, 2019
Identifying Longitudinal CD4:CD8 Ratio Trajectories Indicative of Chronic Renal Disease Risk among People Living with
Alejandra Fonseca-Cuevas1, Patrick Newsome2, Lu Wang1
1British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
Insights
Monitoring the CD4:CD8 ratio in people living with HIV (PLWH) can help detect chronic kidney disease (CKD) early. Specific ratio trajectories indicate higher CKD risk, enabling timely intervention.
Area of Science:
- HIV Medicine
- Nephrology
- Immunology
Background:
- Chronic kidney disease (CKD) incidence is rising in people living with HIV (PLWH).
- Early detection of CKD is crucial for managing PLWH.
- The CD4:CD8 ratio is a potential biomarker for monitoring health status in PLWH.
Purpose of the Study:
- To identify CD4:CD8 ratio trajectories associated with CKD risk in PLWH.
- To determine if routine CD4:CD8 ratio monitoring can aid in early CKD detection.
Main Methods:
- Utilized growth mixture models (GMMs) and decay models to analyze CD4:CD8 ratio trajectories.
- Classified 4863 participants into distinct CD4:CD8 ratio trajectory classes.
- Assessed CKD incidence based on CD4:CD8 ratio patterns over time.
Main Results:
- Two distinct CD4:CD8 ratio trajectories were identified (Class 1 and Class 2).
- Class 2 participants (6.5%) had a significantly higher CKD incidence (20.9%) compared to Class 1 (5.4%).
- Class 2 participants exhibited a significant and accelerating decline in CD4:CD8 ratio, particularly after 5.5 years, preceding CKD development.
Conclusions:
- Specific CD4:CD8 ratio trajectories are clinically relevant indicators of CKD risk in PLWH.
- Routine monitoring of CD4:CD8 ratios offers a viable strategy for early CKD risk identification in this population.
Abstract:
The incidence of chronic kidney disease (CKD) is increasing among people living with HIV (PLWH). Routine monitoring of indicators such as CD4:CD8 ratio might improve the early detection of CKD. Our objective was to identify clinically relevant CD4:CD8 ratio trajectories indicative of CKD risk. Participants were ≥ 18 years old, initiated antiretroviral therapy between 2000 and 2016, and were followed for ≥6 months until 31 March 2017 or last contact date. Outcome was incidence of CKD. Growth mixture models (GMMs) and decay models were used to compare CD4:CD8 ratio trajectories. Following GMM, 4547 (93.5%) participants were classified in Class 1 with 5.4% developing CKD, and 316 (6.5%) participants were classified in Class 2 with 20.9% developing CKD. The final model suggested that participants in Class 2 had 8.72 times the incidence rate of developing CKD than those in Class 1. Exponential decay models indicated a significant CD4:CD8 ratio decline among Class 2 participants who developed CKD. Among those who developed CKD in Class 2, starting at 5.5 years of follow-up, the slope of their ratio trajectory curve changed significantly, and the rate of decline increased dramatically. Routine monitored CD4:CD8 ratios can be an effective strategy to identify early CKD risk among PLWH.
