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Determinants of Restoration of CD4 and CD8 Cell Counts and their Ratio in HIV-1 Positive Individuals with Sustained Virological Suppression on Antiretroviral Therapy

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@article{0a6245c76fd4432b9cb4d32466f58ef7,
title = "Determinants of Restoration of CD4 and CD8 Cell Counts and their Ratio in HIV-1 Positive Individuals with Sustained Virological Suppression on Antiretroviral Therapy",
abstract = "BACKGROUND: An increasing number of HIV-positive individuals now start antiretroviral therapy (ART) with high CD4 cell counts. We 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. METHODS: We determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2309 HIV-negative individuals. We used longitudinal measurements of 60,997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models. RESULTS: 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 <250 CD4 cells/mm. Median CD4:CD8 trajectories did not reach median reference values, even when ART was started at 500 cells/mm. DISCUSSION: 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.",
author = "Luuk Gras and Margaret May and Ryder, {Lars Peter} and Adam Trickey and Marie Helleberg and Niels Obel and Rodolphe Thiebaut and Jodie Guest and John Gill and Heidi Crane and Lima, {Viviane Dias} and Monforte, {Antonella dʼArminio} and Sterling, {Timothy R} and Jose Miro and Santiago Moreno and Christoph Stephan and Colette Smith and Janet Tate and Leah Shepherd and Mike Saag and Armin Rieger and Daniel Gillor and Matthias Cavassini and Marta Montero and Ingle, {Suzanne M} and Peter Reiss and Dominique Costagliola and Wit, {Ferdinand W N M} and Jonathan Sterne and {de Wolf}, Frank and Ronald Geskus and {Antiretroviral Therapy Cohort Collaboration (ART-CC)}",
year = "2019",
month = "3",
day = "1",
doi = "10.1097/QAI.0000000000001913",
language = "English",
volume = "80",
pages = "292--300",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams & Wilkins",
number = "3",

}

RIS

TY - JOUR

T1 - Determinants of Restoration of CD4 and CD8 Cell Counts and their Ratio in HIV-1 Positive Individuals with Sustained Virological Suppression on Antiretroviral Therapy

AU - Gras, Luuk

AU - May, Margaret

AU - Ryder, Lars Peter

AU - Trickey, Adam

AU - Helleberg, Marie

AU - Obel, Niels

AU - Thiebaut, Rodolphe

AU - Guest, Jodie

AU - Gill, John

AU - Crane, Heidi

AU - Lima, Viviane Dias

AU - Monforte, Antonella dʼArminio

AU - Sterling, Timothy R

AU - Miro, Jose

AU - Moreno, Santiago

AU - Stephan, Christoph

AU - Smith, Colette

AU - Tate, Janet

AU - Shepherd, Leah

AU - Saag, Mike

AU - Rieger, Armin

AU - Gillor, Daniel

AU - Cavassini, Matthias

AU - Montero, Marta

AU - Ingle, Suzanne M

AU - Reiss, Peter

AU - Costagliola, Dominique

AU - Wit, Ferdinand W N M

AU - Sterne, Jonathan

AU - de Wolf, Frank

AU - Geskus, Ronald

AU - Antiretroviral Therapy Cohort Collaboration (ART-CC)

PY - 2019/3/1

Y1 - 2019/3/1

N2 - BACKGROUND: An increasing number of HIV-positive individuals now start antiretroviral therapy (ART) with high CD4 cell counts. We 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. METHODS: We determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2309 HIV-negative individuals. We used longitudinal measurements of 60,997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models. RESULTS: 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 <250 CD4 cells/mm. Median CD4:CD8 trajectories did not reach median reference values, even when ART was started at 500 cells/mm. DISCUSSION: 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.

AB - BACKGROUND: An increasing number of HIV-positive individuals now start antiretroviral therapy (ART) with high CD4 cell counts. We 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. METHODS: We determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2309 HIV-negative individuals. We used longitudinal measurements of 60,997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models. RESULTS: 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 <250 CD4 cells/mm. Median CD4:CD8 trajectories did not reach median reference values, even when ART was started at 500 cells/mm. DISCUSSION: 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.

UR - http://www.scopus.com/inward/record.url?scp=85061492577&partnerID=8YFLogxK

U2 - 10.1097/QAI.0000000000001913

DO - 10.1097/QAI.0000000000001913

M3 - Journal article

VL - 80

SP - 292

EP - 300

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 3

ER -

ID: 56392546