Asymptomatic CMV Replication During Early Human Immunodeficiency Virus (HIV) Infection Is Associated With Lower CD4/CD8 Ratio During HIV Treatment.
BACKGROUND
A low CD4/CD8 ratio in human immunodeficiency virus (HIV)-infected individuals is associated with inflammation and higher risk of non-AIDS morbidity and mortality. In this study, we investigated the effect of subclinical cytomegalovirus (CMV) and Epstein-Barr virus (EBV) replication on CD4+and CD8+T-cell dynamics when antiretroviral therapy (ART) is started during early infection.


METHODS
We investigated 604 peripheral blood mononuclear cell samples from 108 CMV- and EBV-seropositive HIV-infected men who have sex with men, who started ART within a median of 4 months from their estimated date of infection and were followed for a median of 29.1 months thereafter. Levels of CMV and EBV DNA were measured at each timepoint. Mixed-effects asymptotic regression models were applied to characterize CD4+and CD8+T-cell dynamics, and Bayesian hierarchical models were used to quantify individual differences in CMV and EBV DNA replication.


RESULTS
Higher levels of subclinical CMV replication were associated with lower predicted maximum levels of CD4/CD8 ratio (P < .05), which was driven by higher levels of CD8+T-cell counts (P < .05), without affecting CD4+T-cell counts (P > .1). Age was negatively associated with CD4/CD8 levels (P < .05), and this effect was independent of the CMV association (P < .05 for both CMV and age in a multivariate model).


CONCLUSIONS
Subclinical CMV replication in blood cells during early HIV infection and younger age were associated with lower CD4/CD8 ratios during suppressive ART. These findings suggest that active CMV infection in the setting of treated HIV may represent an attractive potential target for therapeutic intervention.
University of California, San Diego, La Jolla.|Veterans Affairs San Diego Healthcare System, San Diego, California.
Davey M
DM
Smith
University of California, San Diego, La Jolla.
Masato
M
Nakazawa
Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, Ohio.
Michael L
ML
Freeman
University of California, San Diego, La Jolla.
Christy M
CM
Anderson
University of California, San Diego, La Jolla.
Michelli F
MF
Oliveira
University of California, San Diego, La Jolla.
Susan J
SJ
Little
University of California, San Diego, La Jolla.
Sara
S
Gianella
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D058345:Asymptomatic Infections; D001499:Bayes Theorem; D016516:CD4-CD8 Ratio; D003587:Cytomegalovirus / Q000235:genetics / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000276:immunology / Q000821:virology*; D004279:DNA, Viral / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000276:immunology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D006679:HIV Seropositivity; D015497:HIV-1 / Q000276:immunology / Q000302:isolation & purification; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology / Q000502:physiology; D006801:Humans; D008297:Male; D012044:Regression Analysis; D019562:Viral Load; D014779:Virus Replication
D004279:DNA, Viral
ART; CD4/CD8 ratio; Epstein-Barr virus; HIV; cytomegalovirus