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. 2023 Feb 1;92(2):180-188.
doi: 10.1097/QAI.0000000000003121.

CD4/CD8 Ratio Recovery Among People Living With HIV Starting With First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis

Win Min Han  1   2 , Anchalee Avihingsanon  2 , Reena Rajasuriar  3 , Junko Tanuma  4 , Sanjay Mundhe  5 , Man-Po Lee  6 , Jun Yong Choi  7 , Sanjay Pujari  8 , Yu-Jiun Chan  9 , Agus Somia  10 , Fujie Zhang  11 , Nagalingeswaran Kumarasamy  12 , Oon Tek Ng  13 , Yasmin Gani  14 , Romanee Chaiwarith  15 , Thach Ngoc Pham  16 , Cuong Duy Do  17 , Rossana Ditangco  18 , Sasisopin Kiertiburanakul  19 , Vohith Khol  20 , Jeremy Ross  21 , Awachana Jiamsakul  1 ; IeDEA Asia‐Pacific
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CD4/CD8 Ratio Recovery Among People Living With HIV Starting With First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis

Win Min Han et al. J Acquir Immune Defic Syndr. .

Abstract

Background: We evaluated trends in CD4/CD8 ratio among people living with HIV (PLWH) starting antiretroviral therapy (ART) with first-line integrase strand transfer inhibitors (INSTI) compared with non-INSTI-based ART, and the incidence of CD4/CD8 ratio normalization.

Methods: All PLWH enrolled in adult HIV cohorts of IeDEA Asia-Pacific who started with triple-ART with at least 1 CD4, CD8 (3-month window), and HIV-1 RNA measurement post-ART were included. CD4/CD8 ratio normalization was defined as a ratio ≥1. Longitudinal changes in CD4/CD8 ratio were analyzed by linear mixed model, the incidence of the normalization by Cox regression, and the differences in ratio recovery by group-based trajectory modeling.

Results: A total of 5529 PLWH were included; 80% male, median age 35 years (interquartile range [IQR], 29-43). First-line regimens were comprised of 65% NNRTI, 19% PI, and 16% INSTI. The baseline CD4/CD8 ratio was 0.19 (IQR, 0.09-0.33). PLWH starting with NNRTI- (P = 0.005) or PI-based ART (P = 0.030) had lower CD4/CD8 recovery over 5 years compared with INSTI. During 24,304 person-years of follow-up, 32% had CD4/CD8 ratio normalization. After adjusting for age, sex, baseline CD4, HIV-1 RNA, HCV, and year of ART initiation, PLWH started with INSTI had higher odds of achieving CD4/CD8 ratio normalization than NNRTI- (P < 0.001) or PI-based ART (P = 0.015). In group-based trajectory modeling analysis, INSTI was associated with greater odds of being in the higher ratio trajectory.

Conclusions: INSTI use was associated with higher rates of CD4/CD8 ratio recovery and normalization in our cohort. These results emphasize the relative benefits of INSTI-based ART for immune restoration.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Kaplan-Meier estimates of CD4/CD8 ratio normalization by ART regimen (1A) and Group-based trajectory modeling of CD4/CD8 ratio recovery (1B)
See this image and copyright information in PMC

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