The CD4:CD8 ratio is associated with IMT progression in HIV-infected patients on antiretroviral treatment.
BACKGROUND
Inversion of the CD4:CD8 ratio (<1) has been identified as a hallmark of immunosenescence and an independent predictor of mortality in the general population. We aimed to assess the association between the CD4:CD8 ratio and intima-media thickness (IMT) progression in treated HIV-infected patients as a marker of early atherosclerosis.


METHODS
A longitudinal study during three years was conducted in 120 HIV-infected patients receiving antiretroviral treatment (ART). We analyzed the associations between the CD4:CD8 ratio, cardiovascular risk factor and antiretroviral (ARV) treatment and progression of subclinical atherosclerosis assessed using carotid IMT at baseline and after three years.


RESULTS
Finally, 96 patients completed the study. Seventy-six (79.1%) patients were male, aged 44±10 years, 39 (40.6%) were on treatment with Protease inhibitors, 49 (51.04%) with non-nucleoside reverse transcriptase inhibitors (NNRTI), 6 (6.25%) with integrase inhibitors, 3 (3.12%) with maraviroc and 2 (2.08%) only with nucleoside reverse transcriptase inhibitors (NRTI). The mean of ARV exposition was 6.9±5.9 years. Twenty six (27 %) patients had family history of ischemic heart disease, 51 (53.12%) were smokers, 12 (12.5%) hypertensive, 4 (4.16%) type 2 diabetes, 23 (23.9%) with dyslipidemia and 31 (32.3%) were infected with C hepatitis virus. Baseline IMT was significantly associated with age (rho=0.497; p<0.001), basal glucemia (rho=0.323; p=0.001), triglycerides (rho=0.232; p=0.023), Framingham score (rho=0.324; p=0.001), CD4:CD8 ratio (rho=-0.176; p=0.05) and dyslipidemia (0.72±0.16 mm vs 0.63±0.11 mm; p=0.029). In multivariable analysis where cardiovascular risk factor and ARV were included, IMT progression was inversely associated with CD4:CD8 ratio (OR=0.283; CI 95% 0.099-0.809; p=0.019) and treatment with NNRTI (OR=0.283; CI 95% 0.099-0.809; p=0.019).


CONCLUSIONS
The inversion of CD4:CD8 ratio in treated HIV-infected patients is independently associated with IMT progression, a marker of age-associated disease. Therefore, it might be clinically useful as predictor of cardiovascular events. Surprisingly, there was a positive correlation between receiving NNRTI and progression of IMT.
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Enrique
E
Bernal
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Jose
J
Serrano
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Ana
A
Perez
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Salvador
S
Valero
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Eva
E
Garcia
Reina Sofia Hospital, Cardiology, Murcia, Spain.
Irene
I
Marín
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Angeles
A
Muñoz
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Jose Miguel Gomez
JM
Verdú
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Carmen
C
Vera
Reina Sofia Hospital, Infectious Disease Unit, Murcia, Spain.
Alfredo
A
Cano