The CD 4: CD 8 ratio is associated with markers of age‐associated disease in virally suppressed HIV ‐infected patients with immunological recovery

Objectives Inversion of the CD 4: CD 8 ratio (< 1) has been identified as a hallmark of inmmunosenescence and an independent predictor of mortality in the general population. We aimed to assess the association between the CD 4: CD 8 ratio and markers of age‐associated disease in treated HIV ‐infected patients with good immunovirological response. Methods A cross‐sectional analysis was conducted in 132 HIV ‐infected adults on antiretroviral therapy ( ART ), with plasma HIV RNA  < 50 HIV ‐1 RNA copies/mL for at least 1 year, CD 4 count > 350 cells/μL and age < 65 years. We analysed the associations between the CD 4: CD 8 ratio and subclinical atherosclerosis [assessed using carotid intima‐media thickness ( IMT )], arterial stiffness [assessed using the augmentation index ( AIx )], the estimated glomerular filtration rate ( eGFR ), muscle wasting and sarcopenia [assessed using appendicular lean mass/height 2 ( ALM ) measured by dual‐energy X ‐ray absorptiometry ( DEXA )]. Results CD 4: CD 8 ratio inversion was associated with higher IMT , lower eGFR and lower ALM (all values P  < 0.05), but not with AIx . In multivariate analyses adjusted for age, sex, hypertriglyceridaemia, tobacco use and cumulative ART exposure, inversion of the CD 4: CD 8 ratio was independently associated with higher IMT [odds ratio ( OR ) 2.9; 95% confidence interval ( CI ) 1.2–7.1], arterial stiffness ( OR 4.8; 95% CI 1.0–23.5) and lower eGFR ( OR 5.2; 95% CI 1.0–64.4), but not sarcopenia ( OR 0.7; 95% CI 0.2–2.7). These associations persisted when models were applied to subjects with nadir CD 4 counts > 200 cells/μL and those with CD 4 counts > 500 cells/μL. Conclusions The CD 4: CD 8 ratio in treated HIV ‐infected subjects with good immunovirological response is independently associated with markers of age‐associated disease. Hence, it might be a clinically useful predictor of non‐ AIDS ‐defining conditions.