Determinants of Restoration of CD4 and CD8 Cell Counts and Their Ratio in HIV-1-Positive Individuals With Sustained Virological Suppression on Antiretroviral Therapy - Archive ouverte HAL
Article Dans Une Revue Journal of Acquired Immune Deficiency Syndromes - JAIDS Année : 2019

Determinants of Restoration of CD4 and CD8 Cell Counts and Their Ratio in HIV-1-Positive Individuals With Sustained Virological Suppression on Antiretroviral Therapy

1 Stichting HIV Monitoring [Amsterdam]
2 University of Bristol [Bristol]
3 UCPH - University of Copenhagen = Københavns Universitet
4 Rigshospitalet [Copenhagen]
5 SISTM - Statistics In System biology and Translational Medicine
6 BPH - Bordeaux population health
7 Emory University School of Medicine
8 University of Calgary
9 University of Washington [Seattle]
10 British Columbia Centre for Excellence in HIV/AIDS [Vancouver]
11 UBC - University of British Columbia [Canada]
12 UNIMI - Università degli Studi di Milano = University of Milan
13 Vanderbilt University Medical Center [Nashville]
14 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
15 UB - Universitat de Barcelona
16 Hospital Universitario Ramón y Cajal [Madrid]
17 Universitätsklinikum Frankfurt
18 Goethe University Frankfurt
19 UCL - University College of London [London]
20 YSM - Yale School of Medicine [New Haven, Connecticut]
21 UAB - University of Alabama at Birmingham [ Birmingham]
22 Universität Wien = University of Vienna
23 Universität zu Köln = University of Cologne
24 UNIL - Université de Lausanne = University of Lausanne
25 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
26 Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe
27 UvA - University of Amsterdam [Amsterdam] = Universiteit van Amsterdam
28 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
29 SU - Sorbonne Université
30 Amsterdam Institute for Global Health & Development [Amsterdam, The Netherlands]
31 Imperial College London
32 Public Health Service of Amsterdam
33 University of Oxford
John Gill
  • Fonction : Auteur
Jonathan A. C. Sterne
  • Fonction : Auteur
  • PersonId : 1038324

Résumé

BACKGROUND: An increasing number of HIV-positive individuals now start antiretroviral therapy (ART) with high CD4 cell counts. We investigated whether this makes restoration of CD4 and CD8 cell counts and the CD4:CD8 ratio during virologically suppressive ART to median levels seen in HIV-uninfected individuals more likely and whether restoration depends on gender, age, and other individual characteristics. METHODS: We determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2309 HIV-negative individuals. We used longitudinal measurements of 60,997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models. RESULTS: When baseline CD4 cell counts were higher, higher long-term CD4 cell counts and CD4:CD8 ratios were reached. Highest long-term CD4 cell counts were observed in middle-aged individuals. During the first 2 years, median CD8 cell counts converged toward median reference values. However, changes were small thereafter and long-term CD8 cell count levels were higher than median reference values. Median 8-year CD8 cell counts were higher when ART was started with <250 CD4 cells/mm. Median CD4:CD8 trajectories did not reach median reference values, even when ART was started at 500 cells/mm. DISCUSSION: Starting ART with a CD4 cell count of ≥500 cells/mm makes reaching median reference CD4 cell counts more likely. However, median CD4:CD8 ratio trajectories remained below the median levels of HIV-negative individuals because of persisting high CD8 cell counts. To what extent these subnormal immunological responses affect specific clinical endpoints requires further investigation.
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Dates et versions

hal-03161868 , version 2 (05-09-2019)
hal-03161868 , version 1 (08-03-2021)

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Luuk Gras, Margaret May, Lars Peter Ryder, Adam Trickey, Marie Helleberg, et al.. Determinants of Restoration of CD4 and CD8 Cell Counts and Their Ratio in HIV-1-Positive Individuals With Sustained Virological Suppression on Antiretroviral Therapy. Journal of Acquired Immune Deficiency Syndromes - JAIDS, 2019, 80 (3), pp.292-300. ⟨10.1097/QAI.0000000000001913⟩. ⟨hal-03161868v2⟩
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