CD4/CD8 ratio in pregnant women with HIV and its association with pregnancy outcome: data from a national study in Italy

Purpose To evaluate associations between CD4/CD8 ratio and pregnancy outcomes in women with HIV. Methods We evaluated, in a national study of pregnant women with HIV receiving antiretroviral treatment (ART), values of CD4/CD8 ratio at entry in pregnancy, changes between first and third trimester, and possible associations with preterm delivery, low birthweight, and HIV-RNA < 50 copies/ml at third trimester in univariate and multivariate analyses. Results Among 934 women, 536 (57.4%) were already on ART at conception. CD4/CD8 ratio (baseline value 0.570) increased significantly between the first and third trimesters, particularly in women who started ART in pregnancy (+ 0.163, vs. + 0.036 in women already on treatment). The rate of CD4/CD8 ratio normalization, defined by achieving a ratio >= 1 at the third trimester, was 13.2%. In multivariable analyses, women who entered pregnancy with a CD4/CD8 ratio < 0.3, compared to women with ratio >= 1, were almost four-times less likely to have third-trimester HIV-RNA < 50 copies/ml (AOR 0.258, 95%CI 0.111-0.601), and more than twice as likely to have preterm delivery (AOR 2.379, 95%CI 1.082-5.232). For preterm delivery, also a baseline CD4/CD8 ratio between 0.3 and 0.45 was significantly associated with an increased risk (AOR: 3.415, 95%CI 1.690-6.900). Conclusion We described for the first time independent associations of low CD4/CD8 ratio with preterm delivery and HIV-RNA suppression.

Automated summary

This study found that among HIV-positive pregnant women, those with a CD4/CD8 ratio less than 0.3 were more likely to have insufficient HIV-RNA suppression in the third trimester and to deliver preterm compared to women with a ratio of 1 or higher. Additionally, women with a baseline CD4/CD8 ratio between 0.3 and 0.45 were also at increased risk for preterm delivery.