期刊
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
卷 73, 期 1, 页码 69-73出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0000000000001013
关键词
primary HIV infection; seroconversion; acute HIV infection; CD4; CD8 ratio; CD4:CD8; early antiretroviral therapy
资金
- Wellcome Trust [069598]
- Medical Research Council
- Imperial NIHR Biomedical Research Centre
- Gilead Sciences
- Medical Research Council (United Kingdom)
- British HIV Association
- Wellcome Trust through Imperial College
- AbbVie
- Bristol-Myers Squibb
- Janssen
- Merck
- ViiV Healthcare
- Novartis
- Medical Research Council [MC_UU_12023/23, MC_UU_12023/15, MR/N001265/1, MR/L00528X/1] Funding Source: researchfish
- MRC [MR/L00528X/1, MC_UU_12023/15, MR/N001265/1] Funding Source: UKRI
Background:Total CD4(+) T-cell counts predict HIV disease progression but do not necessarily reflect normalization of immune function. CD4/CD8 ratio is a marker of immune dysfunction, a prognostic indicator for non-AIDS mortality, and reflects viral reservoir size. Despite antiretroviral therapy (ART), recovery of CD4/CD8 ratio in chronic HIV infection is incomplete; we hypothesize enhanced CD4/CD8 ratio recovery with earlier treatment initiation in recently infected individuals.Methods:CD4(+) count and CD4/CD8 ratio were analyzed using data from 2 cohorts: SPARTAC trial and the UK HIV Seroconverters Cohort where primary HIV infection (PHI) was defined as within 6 months from estimated date of infection. Using time-to-event methods and Cox proportional hazard models, we examined the effect of CD4/CD8 ratio at seroconversion on disease progression (CD4 <350 cells per cubic millimeter/ART initiation) and factors associated with time from ART initiation to CD4/CD8 normalization (ratio >1.0).Findings:Of 573 seroconverters, 482 (84%) had abnormal CD4/CD8 ratios at HIV seroconversion. Individuals with higher CD4/CD8 ratio at seroconversion were significantly less likely to reach the disease progression endpoint [adjusted hazard ratio (aHR) (95% CI) = 0.52 (0.32 to 0.82), P = 0.005]. The longer the interval between seroconversion and ART initiation [HR (95% CI) = 0.98 per month increase (0.97, 0.99), P < 0.001], the less likely the CD4/CD8 ratio normalization. ART initiation within 6 months from seroconversion was significantly more likely to normalize [HR (95% CI) = 2.47 (1.67 to 3.67), P < 0.001] than those initiating later.Interpretation:Most individuals presenting in PHI have abnormal CD4/CD8 ratios. The sooner the ART is initiated in PHI, the greater the probability of achieving normal CD4/CD8 ratio.
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