Factors Associated with CD4+/CD8+ Ratio Normalization in People Living with HIV During Long-Term ART

Although HIV RNA can be suppressed with antiretroviral therapy (ART), chronic inflammation may persist in people living with HIV (PLWH). Because a low CD4⁺/CD8⁺ ratio is associated with morbidity and mortality, this study aimed to evaluate factors associated with CD4⁺/CD8⁺ ratio normalization, defined as a CD4⁺/CD8⁺ ratio ≥1.

This retrospective cohort study included PLWH aged ≥18 years who were diagnosed between 2010 and 2017 and achieved viral suppression within the first year after starting ART. Data were retrospectively obtained from a tertiary care infectious diseases clinic.

Among 217 patients who received ART for at least 5 years, 187 (86.2%) had a CD4⁺ T-cell count >500 cells/μL at year 5, and 87 (40.1%) achieved a CD4⁺/CD8⁺ ratio ≥1. In multivariable logistic regression, higher baseline CD4⁺ T-cell count and a higher baseline CD4⁺/CD8⁺ ratio were independently associated with CD4⁺/CD8⁺ ratio normalization.

Including immunological markers alongside viral suppression may better reflect treatment success. Baseline immunological status appears to be associated with long-term CD4⁺/CD8⁺ ratio normalization in PLWH receiving suppressive ART. Monitoring these markers may help inform long-term follow-up strategies.