Increased CD4 : CD8 ratio normalization with implementation of current ART management guidelines.

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Abstrakt

Tytuł:: Increased CD4 : CD8 ratio normalization with implementation of current ART management guidelines.
Autorzy:: Zhabokritsky A; Department of Medicine, University Health Network, Toronto, Canada.; Department of Medicine, University of Toronto, Toronto, Canada.
Szadkowski L; Department of Medicine, University Health Network, Toronto, Canada.; Biostatistics Research Unit, University Health Network, Toronto, Canada.
Cooper C; Department of Medicine, University of Ottawa, Ottawa, Canada.; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
Loutfy M; Department of Medicine, University of Toronto, Toronto, Canada.; Women's College Research Institute, Women's College Hospital, Toronto, Canada.
Wong A; Department of Medicine, University of Saskatchewan, Regina, Canada.
McClean A; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Hogg RS; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Walmsley SL; Department of Medicine, University Health Network, Toronto, Canada.; Department of Medicine, University of Toronto, Toronto, Canada.; Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
Corporate Authors:: Canadian Observational Cohort (CANOC) Collaboration
Źródło:: The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2021 Feb 11; Vol. 76 (3), pp. 729-737.
Typ publikacji:: Journal Article; Observational Study; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: 1997- : London : Oxford University Press
Original Publication: London, New York, Academic Press.
MeSH Terms:: Anti-HIV Agents*/therapeutic use
HIV Infections*/drug therapy
Adult ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; CD4-CD8 Ratio ; CD8-Positive T-Lymphocytes ; Canada ; Humans ; Retrospective Studies
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Grant Information:: 02684 Canada CIHR; 136882 Canada CIHR; 134047 Canada CIHR; 143342 Canada CIHR
Contributed Indexing:: Investigator: R Hogg; Z Brumme; AN Burchell; C Cooper; D Kelly; M Klein; A Kroch; M Loutfy; N Machouf; J Montaner; K Salters; J Raboud; C Tsoukas; S Sanche; R Thomas; S Walmsley; A Wong; T Antoniou; A Bayoumi; M Hull; B Nosyk; A Cescon; M Cotterchio; C Goldsmith; S Guillemi; PR Harrigan; M Harris; S Hosein; S Johnston; C Kendall; C Liddy; V Lima; D Moore; A Palmer; S Patterson; P Phillips; A Rachlis; SB Rourke; H Samji; M Smieja; B Trottier; M Wainberg; C Archibald; K Clement; M Doolittle-Romas; L Edmiston; S Gardner; B Huskins; J Lawless; D Lee; R Masching; S Tattle; A Zahirieh; C Allen; S Calvez; G Colley; J Chia; D Corsi; L Gilbert; N Gataric; L Light; D Mackie; C Pexos; S Shurgold; L Szadkowski; C Galanakis; B Yip; J Younger; J Zhu
Substance Nomenclature:: 0 (Anti-HIV Agents)
Entry Date(s):: Date Created: 20201129 Date Completed: 20210705 Latest Revision: 20231110
Update Code:: 20240105
PubMed Central ID:: PMC7879150
DOI:: 10.1093/jac/dkaa484
PMID:: 33249444
: Czasopismo naukowe

Objectives: To determine the time to CD4 : CD8 ratio normalization among Canadian adults living with HIV in the modern ART era. To identify characteristics associated with ratio normalization.
Patients and Methods: Retrospective analysis of the Canadian Observational Cohort (CANOC), an interprovincial cohort of ART-naive adults living with HIV, recruited from 11 treatment centres across Canada. We studied participants initiating ART between 1 January 2011 and 31 December 2016 with baseline CD4 : CD8 ratio <1.0 and ≥2 follow-up measurements. Normalization was defined as two consecutive CD4 : CD8 ratios ≥1.0. Kaplan-Meier estimates and log-rank tests described time to normalization. Univariable and multivariable proportional hazards (PH) models identified factors associated with ratio normalization.
Results: Among 3218 participants, 909 (28%) normalized during a median 2.6 years of follow-up. Participants with higher baseline CD4+ T-cell count were more likely to achieve normalization; the probability of normalization by 5 years was 0.68 (95% CI 0.62-0.74) for those with baseline CD4+ T-cell count >500 cells/mm3 compared with 0.16 (95% CI 0.11-0.21) for those with ≤200 cells/mm3 (P < 0.0001). In a multivariable PH model, baseline CD4+ T-cell count was associated with a higher likelihood of achieving ratio normalization (adjusted HR = 1.5, 95% CI 1.5-1.6 per 100 cells/mm3, P < 0.0001). After adjusting for baseline characteristics, time-dependent ART class was not associated with ratio normalization.
Conclusions: Early ART initiation, at higher baseline CD4+ T-cell counts, has the greatest impact on CD4 : CD8 ratio normalization. Our study supports current treatment guidelines recommending immediate ART start, with no difference in ratio normalization observed based on ART class used.
(© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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