Determinants of restoration of CD4 and CD8 cell counts and their ratio in HIV-1-positive individuals with sustained virological suppression on antiretroviral therapy. Journal of Acquired Immune Deficiency Syndrome.
Restoration of CD4 cell counts and normalization of CD8 cell counts is one major goal of antiretroviral therapy. Over the last years, an increasing number of HIV-positive individuals start antiretroviral therapy (ART) with high CD4 cell counts. Gras et al. from the ART-CC collaboration investigated whether this makes restoration of CD4 and CD8 cell counts and the CD4:CD8 ratio during virologically suppressive ART to median levels seen in HIV-uninfected individuals more likely and whether restoration depends on gender, age, and other individual characteristics.
They determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2’309 HIV-negative individuals and used longitudinal measurements of 60’997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models.
When baseline CD4 cell counts were higher, higher long-term CD4 cell counts and CD4:CD8 ratios were reached. Highest long-term CD4 cell counts were observed in middle-aged individuals. During the first 2 years, median CD8 cell counts converged toward median reference values. However, changes were small thereafter and long-term CD8 cell count levels were higher than median reference values. Median 8-year CD8 cell counts were higher when ART was started with
In summary, starting ART with a CD4 cell count of ≥500 cells/mm makes reaching median reference CD4 cell counts more likely. However, median CD4:CD8 ratio trajectories remained below the median levels of HIV-negative individuals because of persisting high CD8 cell counts. To what extent these subnormal immunological responses affect specific clinical endpoints requires further investigation.