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. 2015 Jun 29;18(1):20052.
doi: 10.7448/IAS.18.1.20052. eCollection 2015.

CD4:CD8 ratio as a frontier marker for clinical outcome, immune dysfunction and viral reservoir size in virologically suppressed HIV-positive patients

Wei Lu  1   2   3 , Vikram Mehraj  1   2 , Kishanda Vyboh  1   2 , Wei Cao  1   2   3 , Taisheng Li  3 , Jean-Pierre Routy  1   2   4
Affiliations

CD4:CD8 ratio as a frontier marker for clinical outcome, immune dysfunction and viral reservoir size in virologically suppressed HIV-positive patients

Wei Lu et al. J Int AIDS Soc. .

Abstract

Introduction: Absolute CD4 T cell count and plasma viral load have been established as predictors of HIV disease progression, and CD4 T cell count is used as an indicator for initiation of antiretroviral therapy. Following long-term therapy, patients generally present with significant CD4 T cell recovery contrasting with persistently elevated CD8 T cell counts, which leads to a partial restoration of CD4:CD8 ratio. This review focuses on the relevance of the CD4:CD8 ratio on clinical outcomes, immune dysfunction and HIV reservoir size in long-term treated patients.

Method: We conducted a comprehensive literature review of publications in English language using major electronic databases. Our search was focused on factors contributing to CD4:CD8 T cell ratio and clinical outcome in adult HIV-positive patients in the context of treated infection.

Discussion: Low CD4:CD8 ratio has been linked to ageing and acts as a predictor of mortality in the general population. This ratio may represent the combined effects of inflammation and immunological changes called "inflammaging." Although the mechanisms underlying partial correction of the CD4:CD8 ratio and persistently elevated CD8 T cell count in long-term treated patients remain poorly understood, it has been recently indicated that patients with optimal CD4 T cell recovery and low CD4:CD8 ratio still harbour increased immune activation, an immune senescent phenotype and have a higher risk of non-AIDS morbidity and mortality. This review reconsiders CD4:CD8 ratio in the light of advances in the understanding of immune dysfunction and examines its pathophysiological features and implications on clinical outcome and HIV reservoir size in long-term treated HIV-positive adults.

Conclusion: The CD4:CD8 ratio can contribute to the immunological evaluation of treated patients in a long-term follow-up and may be applied for monitoring both immune dysfunction and viral reservoir size in immune-based clinical trials.

Keywords: CD4:CD8 ratio; HIV infection; immune dysfunction; inflammation; viral reservoir.

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Figures

Figure 1
Figure 1
Factors associated with low CD4:CD8 ratio in HIV treated infection.
Figure 2
Figure 2
Trajectories of CD4 and CD8 T cells and CD4:CD8 ratio in long-term treated patients. (Advanced patients initiating ART, enrolled in Beijing cohort.)
See this image and copyright information in PMC

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