Impact of first-line antiretroviral therapy regimens on the restoration of the CD4/CD8 ratio in the CNICS cohort
Year: 2020
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The CD4/CD8 ratio is an indicator of immunosenescence and a predictor of all-cause mortality in HIV-infected patients. The effects of different ART regimens on CD4/CD8 ratio recovery remain unclear. METHODS: Clinical cohort study of ART-treated patients from the CFAR Network of Integrated Clinical Systems (CNICS). We included ART-naive adults with HIV infection who achieved undetectable HIV RNA during the first 48 weeks of treatment and had additional follow-up 48 weeks after virological suppression (VS). Primary endpoints included increase in CD4/CD8 ratio at both timepoints and secondary endpoints were CD4/CD8 ratio recovery at cut-offs of ≥0.5 or ≥1.0. RESULTS: Of 3971 subjects who met the study criteria, 1876 started ART with an NNRTI, 1804 with a PI and 291 with an integrase strand transfer inhibitor (INSTI). After adjusting for age, sex, race, year of entry, risk group, HCV serostatus, baseline viral load and baseline CD4/CD8 ratio, subjects on an NNRTI showed a significantly greater CD4/CD8 ratio gain compared with those on a PI, either 48 weeks after ART initiation or after 48 weeks of HIV RNA VS. The greater CD4/CD8 ratio improvement in the NNRTI arm was driven by a higher decline in CD8 counts. The INSTI group showed increased rates of CD4/CD8 ratio normalization at the ≥1.0 cut-off compared with the PI group. CONCLUSIONS: NNRTI therapy was associated with a greater increase in the CD4/CD8 ratio compared with PIs. NNRTI- and INSTI-based first-line ART were associated with higher rates of CD4/CD8 ratio normalization at a cut-off of 1.0 than a PI-based regimen, which might have clinical implications.
DOI: 10.1093/jac/dkaa024
Institutions: Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, University of California, San Francisco, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research, University of Alabama at Birmingham, Northwestern University, Case Western Reserve University, University of California San Diego, Harvard University, Fenway Health, University of North Carolina at Chapel Hill
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: bronze
Funders: University of California, University of North Carolina, University of Washington, Johns Hopkins University, Case Western Reserve University, University of Alabama, National Institutes of Health, University of California, San Diego, University of California, San Francisco, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases
Awards: G134466334, G1531094742, G1641068626, G1939027404, G2122320390, G2127051194, G2219438539, G2483435703, G2516619799, G2839755957, G2898952431, G3040019378, G3181090803, G342295615, G378552126, G3789320706, G3917235369, G4011434182, G4166928756, G4391827178, G4566499748, G4575219416, G4610217253, G495691247, G6333266910, G6345323600, G6471454067, G654751394, G6625095162, G6950284150, G7364671334, G7791962275, G9000036922, G9000054876, G9000058579, G9000074434, G9000075494, G9000078127, G9000081321, G9000100957, G9000121584, G9000124410, G9000129761, G9000186388, G9000189727, G9000343736, San Diego Center for AIDS Research (SD CFAR), Rustbelt Center for AIDS Research (Case/UHC-Pitt CFAR), The Johns Hopkins Center for AIDS Research (JHU CFAR), UAB Center for AIDS Research (CFAR), G90079629, G929137571, G97119092
OpenAlex ID: W3013458479