title: The CD4/CD8 Ratio is Inversely Associated with Carotid Intima-Media Thickness Progression in Human Immunodeficiency Virus-Infected Patients on Antiretroviral Treatment.
abstract: Inversion of the CD4/CD8 ratio (<1) has been identified as a surrogate marker of immunosenescence and an independent predictor of AIDS events in HIV-infected patients and mortality in the general population. We aimed to assess the association between the CD4/CD8 ratio and carotid intima-media thickness (cIMT) progression in treated HIV-infected patients as a marker of coronary heart disease. A longitudinal study was conducted during 3 years in 96 virally suppressed HIV-infected patients receiving antiretroviral treatment (ART). We analyzed the associations between the CD4/CD8 ratio, cardiovascular risk factors, and antiretroviral treatment (ART) and progression of subclinical atherosclerosis assessed using cIMT at baseline and after 3 years. 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 nonnucleoside reverse transcriptase inhibitors, 6 (6.25%) with integrase inhibitors, 3 (3.12%) with maraviroc, and 2 (2.08%) just with nucleoside reverse transcriptase inhibitors. The mean of ART 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%) were hypertensive, 4 (4.16%) had type 2 diabetes, 23 (23.9%) had dyslipidemia, and 31 (32.3%) were infected with hepatitis C virus. Baseline cIMT was significantly associated with age (rho = 0.497; p < .001), basal glucemia (rho = 0.323; p = .001), triglycerides (rho = 0.232; p = .023), Framingham risk score (rho = 0.324; p = .001), CD4/CD8 ratio (rho = -0.176; p = .05), and dyslipidemia (0.72 ± 0.16 mm vs. 0.63 ± 0.11 mm; p = .029). In multivariable analysis where cardiovascular risk factor and ART were included, cIMT progression was inversely associated with CD4/CD8 ratio [odds ratio (OR) = 0.283; confidence interval (95% CI) 0.099-0.809; p = .019]. In conclusion, the inversion of CD4/CD8 ratio in treated HIV-infected patients is independently associated with cIMT progression, a marker of coronary heart disease. Therefore, it might be clinically useful as predictor of cardiovascular events.
authors.affiliation: 1 Sección de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia de Murcia , Murcia, Spain .
authors.forename: Enrique
authors.initials: E
authors.lastname: Bernal Morell
authors.affiliation: 1 Sección de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia de Murcia , Murcia, Spain .
authors.forename: José
authors.initials: J
authors.lastname: Serrano Cabeza
authors.affiliation: 1 Sección de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia de Murcia , Murcia, Spain .
authors.forename: Ángeles
authors.initials: Á
authors.lastname: Muñoz
authors.affiliation: 2 Sección de Cardiología, Hospital General Universitario Reina Sofía de Murcia , Murcia, Spain .
authors.forename: Irene
authors.initials: I
authors.lastname: Marín
authors.affiliation: 3 Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche , Elche, Spain .
authors.forename: Mar
authors.initials: M
authors.lastname: Masiá
authors.affiliation: 3 Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche , Elche, Spain .
authors.forename: Félix
authors.initials: F
authors.lastname: Gutiérrez
authors.affiliation: 1 Sección de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia de Murcia , Murcia, Spain .
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cano
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000473:pathology*; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes; D059168:Carotid Intima-Media Thickness; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D016174:Hepacivirus; D006518:Hepatitis Viruses; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
chemical_list: D044966:Anti-Retroviral Agents