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J Int AIDS Soc. 2015 Jun 29;18:20052. doi: 10.7448/IAS.18.1.20052. eCollection 2015.

CD4:CD8 ratio as a frontier marker for clinical outcome, immune dysfunction and viral reservoir size in virologically suppressed HIV-positive patients.

Lu W1,2,3, Mehraj V1,2, Vyboh K1,2, Cao W1,2,3, Li T3, Routy JP1,2,4.

Author information

1
Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, Quebec, Canada.
2
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
3
Division of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China.
4
Division of Hematology, McGill University Health Centre, Montreal, Quebec, Canada; jean-pierre.routy@mcgill.ca.

Abstract

INTRODUCTION:

Absolute CD4 T cell count and plasma viral load have been established as predictors of HIV disease progression, and CD4 T cell count is used as an indicator for initiation of antiretroviral therapy. Following long-term therapy, patients generally present with significant CD4 T cell recovery contrasting with persistently elevated CD8 T cell counts, which leads to a partial restoration of CD4:CD8 ratio. This review focuses on the relevance of the CD4:CD8 ratio on clinical outcomes, immune dysfunction and HIV reservoir size in long-term treated patients.

METHOD:

We conducted a comprehensive literature review of publications in English language using major electronic databases. Our search was focused on factors contributing to CD4:CD8 T cell ratio and clinical outcome in adult HIV-positive patients in the context of treated infection.

DISCUSSION:

Low CD4:CD8 ratio has been linked to ageing and acts as a predictor of mortality in the general population. This ratio may represent the combined effects of inflammation and immunological changes called "inflammaging." Although the mechanisms underlying partial correction of the CD4:CD8 ratio and persistently elevated CD8 T cell count in long-term treated patients remain poorly understood, it has been recently indicated that patients with optimal CD4 T cell recovery and low CD4:CD8 ratio still harbour increased immune activation, an immune senescent phenotype and have a higher risk of non-AIDS morbidity and mortality. This review reconsiders CD4:CD8 ratio in the light of advances in the understanding of immune dysfunction and examines its pathophysiological features and implications on clinical outcome and HIV reservoir size in long-term treated HIV-positive adults.

CONCLUSION:

The CD4:CD8 ratio can contribute to the immunological evaluation of treated patients in a long-term follow-up and may be applied for monitoring both immune dysfunction and viral reservoir size in immune-based clinical trials.

KEYWORDS:

CD4:CD8 ratio; HIV infection; immune dysfunction; inflammation; viral reservoir

PMID:
26130226
PMCID:
PMC4486418
DOI:
10.7448/IAS.18.1.20052
[Indexed for MEDLINE]
Free PMC Article

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