Open AccessPrognostic factors of a lower CD4/CD8 ratio in long term viral suppression HIV infected children
Author(s) -
Sara Guillén,
Luís Prieto,
Santiago Jiménez de Ory,
María Isabel GonzálezTomé,
Pablo Rojo,
Marı́a Luisa Navarro,
María José Mellado,
Luis Escosa,
Talía Sainz,
Laura Francisco,
María Ángeles MuñozFernández,
José Tomás Ramos
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0220552
Subject(s) - cart , cd4 cd8 ratio , viral load , nadir , medicine , cd8 , univariate analysis , antiretroviral therapy , immune system , multivariate analysis , immunology , gastroenterology , human immunodeficiency virus (hiv) , lymphocyte subsets , mechanical engineering , satellite , aerospace engineering , engineering
Background Combination antiretroviral therapy (cART) is associated with marked immune reconstitution. Although a long term viral suppression is achievable, not all children however, attain complete immunological recovery due to persistent immune activation. We use CD4/CD8 ratio like a marker of immune reconstitution. Methods Perinatal HIV-infected children who underwent a first-line cART, achieved viral suppression in the first year and maintained it for more than 5 years, with no viral rebound were included. Logistic models were applied to estimate the prognostic factors, clinical characteristics at cART start, of a lower CD4/CD8 ratio at the last visit. Results 146 HIV-infected children were included: 77% Caucasian, 45% male and 28% CDC C. Median age at cART initiation was 2.3 years (IQR: 0.5–6.2). 42 (30%) children received mono-dual therapy previously to cART. Time of undetectable viral load was 9.5 years (IQR: 7.8, 12.5). 33% of the children not achieved CD4/CD8 ratio >1. Univariate analysis showed an association between CD4/CD8 <1 with lower CD4 nadir and baseline CD4; older age at diagnosis and at cART initiation; and a previous exposure to mono-dual therapy. Multivariate analysis also revealed relationship between CD4/CD8 <1 and lower CD4 nadir (OR: 1.002, CI 95% 1.000–1.004) as well as previous exposure to mono-dual therapy (OR: 0.16, CI 95% 0.003–0.720). Conclusions CD4/CD8 >1 was not achieved in 33% of the children. Lower CD4 nadir and previous exposure to suboptimal therapy, before initiating cART, are factors showing independently association with a worse immune recovery (CD4/CD8 < 1).