Premium
Compromised CD 4: CD 8 ratio recovery in people living with HIV aged over 50 years: an observational study
Author(s) -
FrancisMorris A,
Mackie NE,
Eliahoo J,
Ramzan F,
Fidler S,
Pollock KM
Publication year - 2020
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12800
Subject(s) - interquartile range , medicine , hazard ratio , viral load , observational study , human immunodeficiency virus (hiv) , proportional hazards model , gastroenterology , immunology , confidence interval
Objectives Persistent CD 4: CD 8 ratio inversion (< 1) is associated with mortality in older people. We investigated the interaction of the effects of baseline CD 8 count and age at HIV diagnosis on CD 4: CD 8 ratio recovery with antiretroviral therapy ( ART ). Methods An observational study (1 January 2007 to 31 December 2016) was carried out using routinely collected data from the HIV outpatient services at Imperial College Healthcare NHS Trust, London, UK . CD 4 and CD 8 counts, prior to and during ART , treatment during primary HIV infection ( PHI ) and HIV ‐1 viral load were included in univariate and multivariate analyses using Cox proportional hazard regression. Results Data were included for 876 patients starting ART , where HIV suppression was achieved. Of these patients, 741 of 876 (84.6%) were male and 507 of 876 (57.9%) were Caucasian. The median time on ART was 38 [interquartile range (IQR) 17–66] months. CD 8 count change on ART was bidirectional; low CD 8 counts (≤ 600 cells/μL) increased and high CD 8 counts (> 900 cells/μL) decreased. The median pre‐ ART CD 4: CD 8 ratio was 0.41 (IQR 0.24–0.63), and recovery (≥ 1) occurred in 274 of 876 patients (31.3%). Pre‐ and post‐ ART CD 4: CD 8 ratios were lower in those aged > 50 years compared with young adults aged 18–30 years ( P < 0.001 and P = 0.002, respectively). After adjustment, younger age at HIV diagnosis ( P < 0.001) and treatment during PHI ( P < 0.001) were favourable for CD 4: CD 8 ratio normalization. Conclusions Older age (> 50 years) at HIV diagnosis was associated with persistent CD 4: CD 8 ratio inversion, whereas treatment of PHI was protective. These findings confirm the need for testing and early treatment of people aged > 50 years, and could be used in a risk management algorithm for enhanced surveillance.