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

Autor:	Gras L; Stichting HIV Monitoring, Amsterdam, the Netherlands., May M; Bristol Medical School, University of Bristol, Bristol, United Kingdom., Ryder LP; Tissue Typing Laboratory, Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark., Trickey A; Bristol Medical School, University of Bristol, Bristol, United Kingdom., Helleberg M; Department of Infectious Diseases, Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Obel N; Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark., Thiebaut R; INSERM, U1219 Bordeaux Population Health Research Centre, Univ. Bordeaux, INRIA SISTM, Bordeaux, France., Guest J; School of Public Health and Emory School of Medicine, Atlanta, GA., Gill J; Division of Infectious Diseases, University of Calgary, Calgary, Alberta, Canada., Crane H; Center for AIDS Research, University of Washington, Seattle, WA., Dias Lima V; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.; Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., dʼArminio Monforte A; Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Milan, Italy., Sterling TR; Vanderbilt University School of Medicine, Nashville, TN., Miro J; Infectious Disease Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain., Moreno S; Hospital Ramón y Cajal, Madrid, Spain., Stephan C; Department of Infectious Diseases, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany., Smith C; Institute of Global Health, UCL, London, United Kingdom., Tate J; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT., Shepherd L; Institute of Global Health, UCL, London, United Kingdom., Saag M; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL., Rieger A; University of Vienna, Vienna, Austria., Gillor D; Universität zu Köln, Cologne, Germany., Cavassini M; Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Montero M; La Fe Hospital, Valencia, Spain., Ingle SM; Bristol Medical School, University of Bristol, Bristol, United Kingdom., Reiss P; Stichting HIV Monitoring, Amsterdam, the Netherlands.; Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands., Costagliola D; Sorbonne Universités UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (UMRS 1136), Paris, France., Wit FWNM; Stichting HIV Monitoring, Amsterdam, the Netherlands.; Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands., Sterne J; Bristol Medical School, University of Bristol, Bristol, United Kingdom., de Wolf F; Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom., Geskus R; Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.; Public Health Service, Amsterdam, the Netherlands.; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2019 Mar 01; Vol. 80 (3), pp. 292-300.
DOI:	10.1097/QAI.0000000000001913
Abstrakt:	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.
Databáze:	MEDLINE
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