title: Factors influencing the normalization of CD4+ T-cell count, percentage and CD4+/CD8+ T-cell ratio in HIV-infected patients on long-term suppressive antiretroviral therapy.
abstract: We evaluated factors associated with normalization of the absolute CD4+ T-cell counts, per cent CD4+ T cells and CD4+/CD8+ T-cell ratio. A multicentre observational study was carried out in patients with sustained HIV-RNA <50 copies/mL. Outcomes were: CD4-count >500/mm(3) and multiple T-cell marker recovery (MTMR), defined as CD4+ T cells >500/mm(3) plus%CD4 T cells >29%plus CD4+/CD8+ T-cell ratio >1. Kaplan-Meier survival analysis and Cox regression analyses to predict odds for achieving outcomes were performed. Three hundred and fifty-two patients were included and followed-up for a median of 4.1 (IQR 2.1-5.9) years, 270 (76.7%) achieving a CD4+ T-cell count >500 cells/mm(3) and 197 (56%) achieving MTMR. Using three separate Cox models for both outcomes we demonstrated that independent predictors were: both absolute CD4+ and CD8+ T-cell counts, %CD4+ T cells, a higher CD4+/CD8+ T-cell ratio, and age. A likelihood-ratio test showed significant improvements in fitness for the prediction of either CD4+ >500/mm(3) or MTMR by multivariable analysis when the other immune markers at baseline, besides the absolute CD4+ count alone, were considered. In addition to baseline absolute CD4+ T-cell counts, pretreatment %CD4+ T cells and the CD4+/CD8+ T-cell ratio influence recovery of T-cell markers, and their consideration should influence the decision to start antiretroviral therapy. However, owing to the small sample size, further studies are needed to confirm these results in relation to clinical endpoints.
authors.affiliation: Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy. torti@med.unibs.it
authors.forename: C
authors.initials: C
authors.lastname: Torti
authors.forename: M
authors.initials: M
authors.lastname: Prosperi
authors.forename: D
authors.initials: D
authors.lastname: Motta
authors.forename: S
authors.initials: S
authors.lastname: Digiambenedetto
authors.forename: F
authors.initials: F
authors.lastname: Maggiolo
authors.forename: G
authors.initials: G
authors.lastname: Paraninfo
authors.forename: D
authors.initials: D
authors.lastname: Ripamonti
authors.forename: G
authors.initials: G
authors.lastname: Cologni
authors.forename: M
authors.initials: M
authors.lastname: Fabbiani
authors.forename: S L
authors.initials: SL
authors.lastname: Caputo
authors.forename: L
authors.initials: L
authors.lastname: Sighinolfi
authors.forename: N
authors.initials: N
authors.lastname: Ladisa
authors.forename: I
authors.initials: I
authors.lastname: El-Hamad
authors.forename: E
authors.initials: E
authors.lastname: Quiros-Roldan
authors.forename: I
authors.initials: I
authors.lastname: Frank
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology* / Q000821:virology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral