CD4/CD8 ratio and CD8 counts predict CD4 response in HIV-1-infected drug naive and in patients on cART. Medicine
Higher plasma HIV RNA levels are known to correlate with CD4 decline and disease progression. The extent to which CD8 cells, in addition to RNA viral load, predict the depletion of CD4 cells is not well characterized in large and well described patient populations. Sauter et al. examined whether past CD8 cell counts contain additional information to determine future CD4 cell counts and investigated this effect separately, for treatment naive individuals and for patients receiving combination antiretroviral therapy (ART).
In both subgroups, 2’500 naive and 8’902 cART patients, past CD4 cells were positively (P<0.0001) and past viral load was negatively (P<0.0001) associated with disease progression measured here as CD4 cell count. Including additionally past CD8 cell counts improved the fit significantly (P<0.0001). The model which includes the lagged levels of CD4 and CD8 as 2 separate predictors was inferior compared to an approach which included the lagged CD4/CD8 ratio instead of the CD8 level.
In sum, the authors could confirm the findings by other studies, which attributed an important role to CD8 cells for describing the HIV-1 disease progression and could show that the CD4/CD8 ratio is an important time-dependent prognostic factor, for treatment naive and newly also for cART-treated patients. The additional information captured by the CD8 levels and even more by the CD4/CD8 ratio clearly improves prediction models for CD4 counts in addition to the viral load.
Additional comment Dr. Dominique Braun and Prof. Huldrych Günthard
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