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. 2023 May 3;76(9):1688-1696.
doi: 10.1093/cid/ciad136.

CD4/CD8 Ratio During Human Immunodeficiency Virus Treatment: Time for Routine Monitoring?

Raquel Ron  1   2 , Elena Moreno  2   3 , Javier Martínez-Sanz  1   2 , Fátima Brañas  4 , Talía Sainz  5 , Santiago Moreno  1   2   6 , Sergio Serrano-Villar  1   2   7
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CD4/CD8 Ratio During Human Immunodeficiency Virus Treatment: Time for Routine Monitoring?

Raquel Ron et al. Clin Infect Dis. .

Abstract

In the last decade, studies in persons with HIV (PWH) on antiretroviral therapy (ART) have shed light on the significance of persistently high CD8 counts and low CD4/CD8 ratios. A low CD4/CD8 ratio reflects increased immune activation and is associated with an increased risk of severe non-AIDS events. As a result, many clinicians now believe that the CD4/CD8 ratio can help in HIV monitoring, and many researchers now report it as an efficacy marker in interventional studies. However, the topic is more complex. Recent studies have not yielded unanimous conclusions on the ability of the CD4/CD8 ratio to predict adverse outcomes, and only some clinical guidelines recommend monitoring it. Knowledge gaps remain on the best cutoff points, associated clinical events, effects of treatments, and how the CD4/CD8 ratio could improve decision making in the clinic. Here, we critically review the literature, identify knowledge gaps, and discuss the role of the CD4/CD8 ratio as a marker for HIV monitoring.

Keywords: CD4/CD8 ratio; CD8 counts; HIV monitoring; mortality; non-AIDS events.

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Conflict of interest statement

Potential conflicts of interest . J. M.-S. and R. R. have received nonfinancial support from ViiV Healthcare, Janssen Cilag, and Gilead Sciences, outside the submitted work. J. M.-S. reports consulting fees from Gilead Sciences; payment or honoraria from Gilead Sciences, ViiV Healthcare, and Janssen Cilag; and travel support for attending conferences from ViiV Healthcare and Gilead. R. R. reports honoraria from Gilead Sciences for presenting at an educational event and travel support for conferences from Janssen-Cilag. S. M. reports grants, personal fees, and nonfinancial travel support from ViiV Healthcare; grants, personal fees, and nonfinancial support from Gilead; personal fees and nonfinancial travel support from Janssen; and grants, personal fees, and nonfinancial travel support from Merck, Sharp and Dohme (MSD), outside the submitted work. S. M. also reports participation on a Data Safety Monitoring or Advisory Board for MSD. E. M. reports nonfinancial and/or travel support for conferences from ViiV Healthcare and Gilead Sciences, outside the submitted work. T. S. reports grants from MSD and Gilead, outside the submitted work. S. S.-V. reports personal fees including payment or honoraria from Gilead Sciences and MSD, consulting fees from Mikrobiomik and Aptatargets, nonfinancial and/or travel support for conferences from ViiV Healthcare and Gilead Sciences, and research grants from MSD and Gilead Sciences, paid to their institution outside the submitted work. S. S.-V. also reports planned, issued, or pending patents for microbiome-associated biomarkers of anal cancer and a SARS-CoV-2 susceptibility test in saliva. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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