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Clin Infect Dis. 2017 Sep 15;65(6):959-966. doi: 10.1093/cid/cix466.

CD4:CD8 Ratio and CD8 Count as Prognostic Markers for Mortality in Human Immunodeficiency Virus-Infected Patients on Antiretroviral Therapy: The Antiretroviral Therapy Cohort Collaboration (ART-CC).

Author information

1
School of Social and Community Medicine, University of Bristol, United Kingdom.
2
Department I for Internal Medicine, University Hospital of Cologne, Germany.
3
Yale University School of Medicine, West Haven, Connecticut.
4
HIV Atlanta Veterans Affairs Cohort Study, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.
5
Division of Infectious Diseases, University of Calgary, Alberta, Canada.
6
Innsbruck Medical University, Austria.
7
Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham.
8
Stichting HIV Monitoring, and Division of Infectious Diseases and Department of Global Health, Academic Medical Center, University of Amsterdam, and Amsterdam Institute for Global Health and Development, The Netherlands.
9
Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Italy.
10
Department of HIV Medicine, Royal Free London NHS Foundation Trust, United Kingdom.
11
British Columbia Centre for Excellence in HIV/AIDS, and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
12
Vanderbilt University School of Medicine, Nashville, Tennessee.
13
Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland.
14
INSERM, Unit of Epidemiology and Biostatistics, Bordeaux.
15
Sorbonne Universités, INSERM, UPMC Université Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.

Abstract

Background:

We investigated whether CD4:CD8 ratio and CD8 count were prognostic for all-cause, AIDS, and non-AIDS mortality in virologically suppressed patients with high CD4 count.

Methods:

We used data from 13 European and North American cohorts of human immunodeficiency virus-infected, antiretroviral therapy (ART)-naive adults who started ART during 1996-2010, who were followed from the date they had CD4 count ≥350 cells/μL and were virologically suppressed (baseline). We used stratified Cox models to estimate unadjusted and adjusted (for sex, people who inject drugs, ART initiation year, and baseline age, CD4 count, AIDS, duration of ART) all-cause and cause-specific mortality hazard ratios for tertiles of CD4:CD8 ratio (0-0.40, 0.41-0.64 [reference], >0.64) and CD8 count (0-760, 761-1138 [reference], >1138 cells/μL) and examined the shape of associations using cubic splines.

Results:

During 276526 person-years, 1834 of 49865 patients died (249 AIDS-related; 1076 non-AIDS-defining; 509 unknown/unclassifiable deaths). There was little evidence that CD4:CD8 ratio was prognostic for all-cause mortality after adjustment for other factors: the adjusted hazard ratio (aHR) for lower vs middle tertile was 1.11 (95% confidence interval [CI], 1.00-1.25). The association of CD8 count with all-cause mortality was U-shaped: aHR for higher vs middle tertile was 1.13 (95% CI, 1.01-1.26). AIDS-related mortality declined with increasing CD4:CD8 ratio and decreasing CD8 count. There was little evidence that CD4:CD8 ratio or CD8 count was prognostic for non-AIDS mortality.

Conclusions:

In this large cohort collaboration, the magnitude of adjusted associations of CD4:CD8 ratio or CD8 count with mortality was too small for them to be useful as independent prognostic markers in virally suppressed patients on ART.

KEYWORDS:

CD4:CD8 ratio; CD8 count; HIV; antiretroviral therapy; mortality

PMID:
28903507
PMCID:
PMC5850630
DOI:
10.1093/cid/cix466
[Indexed for MEDLINE]
Free PMC Article

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