Combining CD4 recovery and CD4: CD8 ratio restoration as an indicator for evaluating the outcome of continued antiretroviral therapy: an observational cohort study

Objectives Immune recovery following highly active antiretroviral therapy (HAART) is commonly assessed by the degree of CD4 reconstitution alone. In this study, we aimed to assess immune recovery by incorporating both CD4 count and CD4: CD8 ratio. Design Observational cohort study Setting and participants Clinical data from Chinese HIV-positive patients attending the largest HIV service in Hong Kong and who had been on HAART for >= 4 years were accessed. Main outcome measures Optimal immune outcome was defined as a combination of a CD4 count >= 500/mu L and a CD4: CD8 ratio >= 0.8. Results A total of 718 patients were included for analysis (6353 person-years). At the end of year 4, 318 out of 715 patients achieved CD4 >= 500/mu L, of which only 33% (105 out of 318) concurrently achieved CD4: CD8 ratio >= 0.8. Patients with a pre-HAART CD8 <= 800/mu L (428 out of 704) were more likely to be optimal immune outcome achievers with CD4 >= 500/mu L and CD4: CD8 ratio >= 0.8, the association of which was stronger after adjusting for pre-HAART CD4 counts. In a multivariable logistic model, optimal immune outcome was positively associated with male gender, younger pre-HAART age and higher pre-HAART CD4 count, longer duration of HAART and pre-HAART CD8 <= 800/mu L. Treatment regimen and cumulative viral loads played no significant role in the pattern of immune recovery. Conclusions A combination of CD4 count and CD4: CD8 ratio could be a useful approach for the characterisation of treatment outcome over time, on top of monitoring CD4 count alone.