Coinfection by Hepatitis C Is Strongly Associated with Abnormal CD4/CD8 Ratio in HIV Patients under Stable ART in Salvador, Brazil.
Proper immune restoration (CD4 count >500 and normal CD4/8 ratio) is reached only by a fraction of HIV patients, despite stable viral suppression.


METHODS
We present a case-control study to compare HIV patients with viral suppression >1 year, according to immune restoration pattern: adequate response (AR) defined by CD4 > 500 cells/mm(3) and CD4/8 ratio >1; partial response (PR = patients with CD4 > 500, but CD4/8 ratio <1); inadequate response (IR = CD4 < 500 cells).


RESULTS
We evaluated 293 consecutive patients (89 AR, 112 PR, and 92 IR), 70% males. Male gender (p < 0.01), lower mean CD4 nadir (p < 0.001), higher baseline VL (p = 0.01), previous diagnosis of Tb (p = 0.03), or HCV (p < 0.01) was associated with IR. Likelihood of AR/PR was similar regardless of gender, after adjusting for nadir CD4+ cells count. Longer time under suppressive ART was also associated with a greater chance of AR, but logistic regression identified coinfection by HCV as the main factor associated with abnormal CD4/CD8 ratio.


CONCLUSIONS
Early initiation of ART and longer time since first undetectable PVL were predictors of AR. Previous HCV diagnosis significantly increases the risk of abnormal CD4/CD8 ratio.
Laboratorio de Pesquisas em Infectologia, Complexo Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
Clara
C
Brites-Alves
Laboratorio de Pesquisas em Infectologia, Complexo Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
Eduardo Martins
EM
Netto
Laboratorio de Pesquisas em Infectologia, Complexo Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
Carlos
C
Brites
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D016022:Case-Control Studies; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology* / Q000821:virology; D006526:Hepatitis C / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged