title: The CD4:CD8 ratio is associated with markers of age-associated disease in virally suppressed HIV-infected patients with immunological recovery.
abstract: OBJECTIVE
  Inversion of the CD4:CD8 ratio (< 1) has been identified as a hallmark of inmmunosenescence and an independent predictor of mortality in the general population. We aimed to assess the association between the CD4:CD8 ratio and markers of age-associated disease in treated HIV-infected patients with good immunovirological response.
  
  
  METHODS
  A cross-sectional analysis was conducted in 132 HIV-infected adults on antiretroviral therapy (ART), with plasma HIV RNA < 50 HIV-1 RNA copies/mL for at least 1 year, CD4 count > 350 cells/μL and age < 65 years. We analysed the associations between the CD4:CD8 ratio and subclinical atherosclerosis [assessed using carotid intima-media thickness (IMT)], arterial stiffness [assessed using the augmentation index (AIx)], the estimated glomerular filtration rate (eGFR), muscle wasting and sarcopenia [assessed using appendicular lean mass/height(2) (ALM) measured by dual-energy X-ray absorptiometry (DEXA)].
  
  
  RESULTS
  CD4:CD8 ratio inversion was associated with higher IMT, lower eGFR and lower ALM (all values P < 0.05), but not with AIx. In multivariate analyses adjusted for age, sex, hypertriglyceridaemia, tobacco use and cumulative ART exposure, inversion of the CD4:CD8 ratio was independently associated with higher IMT [odds ratio (OR) 2.9; 95% confidence interval (CI) 1.2-7.1], arterial stiffness (OR 4.8; 95% CI 1.0-23.5) and lower eGFR (OR 5.2; 95% CI 1.0-64.4), but not sarcopenia (OR 0.7; 95% CI 0.2-2.7). These associations persisted when models were applied to subjects with nadir CD4 counts > 200 cells/μL and those with CD4 counts > 500 cells/μL.
  
  
  CONCLUSIONS
  The CD4:CD8 ratio in treated HIV-infected subjects with good immunovirological response is independently associated with markers of age-associated disease. Hence, it might be a clinically useful predictor of non-AIDS-defining conditions.
authors.affiliation: Infectious Diseases Department, University Hospital Ramón y Cajal, Madrid, Spain; Health Research Institute Ramón y Cajal (IRYCIS), Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Serrano-Villar
authors.forename: S
authors.initials: S
authors.lastname: Moreno
authors.forename: M
authors.initials: M
authors.lastname: Fuentes-Ferrer
authors.forename: C
authors.initials: C
authors.lastname: Sánchez-Marcos
authors.forename: M
authors.initials: M
authors.lastname: Avila
authors.forename: T
authors.initials: T
authors.lastname: Sainz
authors.forename: N G P
authors.initials: NG
authors.lastname: de Villar
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Cruz
authors.forename: V
authors.initials: V
authors.lastname: Estrada
mesh_terms: D000328:Adult; D000367:Age Factors; D000375:Aging / Q000276:immunology*; D050197:Atherosclerosis / Q000276:immunology / Q000473:pathology; D015415:Biomarkers; D016516:CD4-CD8 Ratio; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D019247:HIV Wasting Syndrome / Q000473:pathology; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018908:Muscle Weakness / Q000276:immunology; D055948:Sarcopenia / Q000473:pathology; D014652:Vascular Diseases / Q000209:etiology / Q000473:pathology; D059289:Vascular Stiffness / Q000276:immunology
chemical_list: D015415:Biomarkers
keywords: CD4:CD8 ratio; HIV; carotid intima-media thickness; premature aging; sarcopenia; vascular stiffness