CD4+:CD8+ T-cell ratio changes in people with HIV receiving antiretroviral treatment.

IF 1.3 4区 医学 Q4 INFECTIOUS DISEASES
Antiviral Therapy Pub Date : 2020-01-01 DOI:10.3851/IMP3354
Maria J Vivancos-Gallego, Hajra Okhai, Maria J Perez-Elías, Cristina Gomez-Ayerbe, Ana Moreno-Zamora, Jose L Casado, Carmen Quereda, Javier Martinez Sanz, Matilde Sanchez-Conde, Sergio Serrano-Villar, Santos Del Campo, Fernando Dronda, Juan Carlos Galan, Caroline A Sabin, Santiago Moreno
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引用次数: 4

Abstract

Background: Cofactors associated with persistently abnormal CD4+:CD8+ T-cell ratio in people with HIV (PWH) on antiretroviral treatment (ART) might change over time as the population of people with HIV ages or as new ART drugs become available. The main objective of our study was to determine the long-term associations of baseline factors, including the CD4+ T-cell count and ratio, with ratio normalization (≥1). In addition to this, we explored whether the ratio remained associated with the risk of both AIDS and non-AIDS events among individuals on suppressive ART.

Methods: Clinic-based study in a tertiary, university hospital in Madrid. People with HIV starting a first-line ART regimen (January 2006-June 2017) were included in a prospective national multicentre cohort (CoRIS). People with controlled HIV-infection within the first year of ART initiation and complete CD4+ and CD8+ T-cell records were selected. Cox proportional hazard (PH) regression models were used to estimate the cumulative incidence of ratio normalization and to examine associations with socio-demographic and clinical variables. To investigate factors independently associated with the development of AIDS and non-AIDS events we used a time updated Poisson regression model.

Results: The study included 557 subjects. During follow-up (median 5.24 years), 44% of participants achieved a ratio of 1 within a median of 1.49 years. In a multivariate PH model, pre-ART factors negatively associated with ratio normalization were the pre-ART CD4+:CD8+ T-cell ratio and mode of HIV acquisition. For the secondary analysis, 1.3 events/100 person years of follow-up were observed. After adjustment, older age, HIV RNA >200 copies/ml and CD4+:CD8+ T-cell ratios over follow-up, remained significantly associated with the development of AIDS and non-AIDS events. In contrast, pre-ART ratio was not associated with the risk of AIDS and non-AIDS events.

Conclusions: In summary, our study showed that higher pre-ART CD4+:CD8+ T-cell ratio is associated with rates of ratio normalization ≥1. In addition, the risk of AIDS and non-AIDS events seems to be predicted by the time updated CD4+:CD8+ T-cell ratio not by the pre-ART CD4+:CD8+ T-cell ratio. Therefore, CD4+:CD8+ T-cell ratio should be considered as a dynamic marker for translation into clinical practice.

接受抗逆转录病毒治疗的艾滋病毒感染者CD4+:CD8+ t细胞比率的变化。
背景:在接受抗逆转录病毒治疗(ART)的HIV感染者(PWH)中,与CD4+:CD8+ t细胞比率持续异常相关的辅助因子可能随着HIV感染者年龄的增长或新的ART药物的出现而发生变化。本研究的主要目的是确定基线因素(包括CD4+ t细胞计数和比值)与比值正常化(≥1)的长期关系。除此之外,我们还探讨了在接受抑制性抗逆转录病毒治疗的个体中,该比率是否仍然与艾滋病和非艾滋病事件的风险相关。方法:在马德里某大学附属医院进行临床研究。从2006年1月至2017年6月开始接受一线抗逆转录病毒治疗的艾滋病毒感染者被纳入前瞻性国家多中心队列(CoRIS)。选择在抗逆转录病毒治疗开始一年内hiv感染得到控制并有完整CD4+和CD8+ t细胞记录的人。Cox比例风险(PH)回归模型用于估计比率归一化的累积发生率,并检查与社会人口统计学和临床变量的关联。为了研究与艾滋病和非艾滋病事件发展相关的独立因素,我们使用了一个时间更新的泊松回归模型。结果:共纳入557名受试者。在随访期间(中位数5.24年),44%的参与者在中位数1.49年内达到了1的比率。在一个多变量PH模型中,art前与比值正常化负相关的因素是art前CD4+:CD8+ t细胞比值和HIV获取方式。在二次分析中,观察到1.3个事件/100人年的随访。调整后,年龄较大、HIV RNA >200拷贝/ml和CD4+:CD8+ t细胞比例在随访期间仍与艾滋病和非艾滋病事件的发展显著相关。相比之下,抗逆转录病毒治疗前的比例与艾滋病和非艾滋病事件的风险无关。结论:总之,我们的研究表明,art前较高的CD4+:CD8+ t细胞比值与比值正常化率≥1相关。此外,艾滋病和非艾滋病事件的风险似乎是通过时间更新的CD4+:CD8+ t细胞比率来预测的,而不是通过art前CD4+:CD8+ t细胞比率来预测的。因此,CD4+:CD8+ t细胞比值应作为一种动态指标,用于临床应用。
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来源期刊
Antiviral Therapy
Antiviral Therapy 医学-病毒学
CiteScore
2.60
自引率
8.30%
发文量
35
审稿时长
4-8 weeks
期刊介绍: Antiviral Therapy (an official publication of the International Society of Antiviral Research) is an international, peer-reviewed journal devoted to publishing articles on the clinical development and use of antiviral agents and vaccines, and the treatment of all viral diseases. Antiviral Therapy is one of the leading journals in virology and infectious diseases. The journal is comprehensive, and publishes articles concerning all clinical aspects of antiviral therapy. It features editorials, original research papers, specially commissioned review articles, letters and book reviews. The journal is aimed at physicians and specialists interested in clinical and basic research.
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