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Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+ :  CD8+ ratio

Hughes, RA; May, MT; Tilling, K; Taylor, N; Wittkop, L; Reiss, P; Gill, J; ... Sterne, JAC; + view all (2018) Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+ :  CD8+ ratio. AIDS , 32 (10) pp. 1361-1367. 10.1097/QAD.0000000000001848. Green open access

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Abstract

OBJECTIVE: Model trajectories of CD4 and CD8 cell counts after starting combination antiretroviral therapy (ART) and use the model to predict trends in these counts and the CD4 : CD8 ratio. DESIGN: Cohort study of antiretroviral-naïve HIV-positive adults who started ART after 1997 (ART Cohort Collaboration) with more than 6 months of follow-up data. METHODS: We jointly estimated CD4 and CD8 cell count trends and their correlation using a bivariate random effects model, with linear splines describing their population trends, and predicted the CD4 : CD8 ratio trend from this model. We assessed whether CD4 and CD8 cell count trends and the CD4 : CD8 ratio trend varied according to CD4 cell count at start of ART (baseline), and, whether these trends differed in patients with and without virological failure more than 6 months after starting ART. RESULTS: A total of 39 979 patients were included (median follow-up was 53 months). Among patients with baseline CD4 cell count at least 50 cells/μl, predicted mean CD8 cell counts continued to decrease between 3 and 15 years post-ART, partly driving increases in the predicted mean CD4 : CD8 ratio. During 15 years of follow-up, normalization of the predicted mean CD4 : CD8 ratio (to >1) was only observed among patients with baseline CD4 cell count at least 200 cells/μl. A higher baseline CD4 cell count predicted a shorter time to normalization. CONCLUSION: Declines in CD8 cell count and increases in CD4 : CD8 ratio occurred up to 15 years after starting ART. The likelihood of normalization of the CD4 : CD8 ratio is strongly related to baseline CD4 cell count.

Type: Article
Title: Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+ :  CD8+ ratio
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000001848
Publisher version: http://doi.org/110.1097/QAD.0000000000001848
Language: English
Additional information: Copyright Q 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Keywords: CD4þ cell count, CD4þ : CD8þ ratio, CD8þ cell count, combination antiretroviral therapy, HIV
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10051826
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