Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection
Autor(a) principal: | |
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Data de Publicação: | 2024 |
Outros Autores: | , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista do Instituto de Medicina Tropical de São Paulo |
Texto Completo: | https://www.revistas.usp.br/rimtsp/article/view/221770 |
Resumo: | Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors. |
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Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infectionHuman immunodeficiency virusHIV-1Early therapyAntiretroviral therapycARTNon-HIV-associated diseasesCD4 /CD8 ratioDespite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo2024-02-05info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/rimtsp/article/view/22177010.1590/S1678-9946202466007 Revista do Instituto de Medicina Tropical de São Paulo; Vol. 66 (2024); e07Revista do Instituto de Medicina Tropical de São Paulo; v. 66 (2024); e07Revista do Instituto de Medicina Tropical de São Paulo; Vol. 66 (2024); e071678-99460036-4665reponame:Revista do Instituto de Medicina Tropical de São Pauloinstname:Instituto de Medicina Tropical (IMT)instacron:IMTenghttps://www.revistas.usp.br/rimtsp/article/view/221770/202703Copyright (c) 2024 Gabriela da Silva Prates, Mariana Amelia Monteiro, Éricka Constantinov Oliveira, Najara Ataide de Lima Nascimento, Ana Paula Rocha Veiga, Mauricio Domingues Ferreira, Thales José Bueno Polis, Gabriela Prandi Caetano, Beatriz Rodrigues Pellegrina Soares, Marcello Mihailenko Chaves Magri, Luisa Oliveira Pereira, Luiz Augusto Marcondes Fonseca, Wagner Silva Alves, Alberto José da Silva Duarte, Jorge Simão do Rosário Cassebhttps://creativecommons.org/licenses/by-nc/4.0info:eu-repo/semantics/openAccessPrates, Gabriela da Silva Monteiro, Mariana Amelia Oliveira, Éricka Constantinov Nascimento, Najara Ataide de Lima Veiga, Ana Paula Rocha Ferreira, Mauricio Domingues Polis, Thales José Bueno Caetano, Gabriela PrandiSoares, Beatriz Rodrigues Pellegrina Magri, Marcello Mihailenko Chaves Pereira, Luisa OliveiraFonseca, Luiz Augusto Marcondes Alves, Wagner SilvaDuarte, Alberto José da Silva Casseb, Jorge Simão do Rosário 2024-05-06T14:04:52Zoai:revistas.usp.br:article/221770Revistahttp://www.revistas.usp.br/rimtsp/indexPUBhttps://www.revistas.usp.br/rimtsp/oai||revimtsp@usp.br1678-99460036-4665opendoar:2024-05-06T14:04:52Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT)false |
dc.title.none.fl_str_mv |
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection |
title |
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection |
spellingShingle |
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection Prates, Gabriela da Silva Human immunodeficiency virus HIV-1 Early therapy Antiretroviral therapy cART Non-HIV-associated diseases CD4 /CD8 ratio |
title_short |
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection |
title_full |
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection |
title_fullStr |
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection |
title_full_unstemmed |
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection |
title_sort |
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection |
author |
Prates, Gabriela da Silva |
author_facet |
Prates, Gabriela da Silva Monteiro, Mariana Amelia Oliveira, Éricka Constantinov Nascimento, Najara Ataide de Lima Veiga, Ana Paula Rocha Ferreira, Mauricio Domingues Polis, Thales José Bueno Caetano, Gabriela Prandi Soares, Beatriz Rodrigues Pellegrina Magri, Marcello Mihailenko Chaves Pereira, Luisa Oliveira Fonseca, Luiz Augusto Marcondes Alves, Wagner Silva Duarte, Alberto José da Silva Casseb, Jorge Simão do Rosário |
author_role |
author |
author2 |
Monteiro, Mariana Amelia Oliveira, Éricka Constantinov Nascimento, Najara Ataide de Lima Veiga, Ana Paula Rocha Ferreira, Mauricio Domingues Polis, Thales José Bueno Caetano, Gabriela Prandi Soares, Beatriz Rodrigues Pellegrina Magri, Marcello Mihailenko Chaves Pereira, Luisa Oliveira Fonseca, Luiz Augusto Marcondes Alves, Wagner Silva Duarte, Alberto José da Silva Casseb, Jorge Simão do Rosário |
author2_role |
author author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Prates, Gabriela da Silva Monteiro, Mariana Amelia Oliveira, Éricka Constantinov Nascimento, Najara Ataide de Lima Veiga, Ana Paula Rocha Ferreira, Mauricio Domingues Polis, Thales José Bueno Caetano, Gabriela Prandi Soares, Beatriz Rodrigues Pellegrina Magri, Marcello Mihailenko Chaves Pereira, Luisa Oliveira Fonseca, Luiz Augusto Marcondes Alves, Wagner Silva Duarte, Alberto José da Silva Casseb, Jorge Simão do Rosário |
dc.subject.por.fl_str_mv |
Human immunodeficiency virus HIV-1 Early therapy Antiretroviral therapy cART Non-HIV-associated diseases CD4 /CD8 ratio |
topic |
Human immunodeficiency virus HIV-1 Early therapy Antiretroviral therapy cART Non-HIV-associated diseases CD4 /CD8 ratio |
description |
Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors. |
publishDate |
2024 |
dc.date.none.fl_str_mv |
2024-02-05 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/rimtsp/article/view/221770 10.1590/S1678-9946202466007 |
url |
https://www.revistas.usp.br/rimtsp/article/view/221770 |
identifier_str_mv |
10.1590/S1678-9946202466007 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/rimtsp/article/view/221770/202703 |
dc.rights.driver.fl_str_mv |
https://creativecommons.org/licenses/by-nc/4.0 info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
https://creativecommons.org/licenses/by-nc/4.0 |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo |
publisher.none.fl_str_mv |
Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo |
dc.source.none.fl_str_mv |
Revista do Instituto de Medicina Tropical de São Paulo; Vol. 66 (2024); e07 Revista do Instituto de Medicina Tropical de São Paulo; v. 66 (2024); e07 Revista do Instituto de Medicina Tropical de São Paulo; Vol. 66 (2024); e07 1678-9946 0036-4665 reponame:Revista do Instituto de Medicina Tropical de São Paulo instname:Instituto de Medicina Tropical (IMT) instacron:IMT |
instname_str |
Instituto de Medicina Tropical (IMT) |
instacron_str |
IMT |
institution |
IMT |
reponame_str |
Revista do Instituto de Medicina Tropical de São Paulo |
collection |
Revista do Instituto de Medicina Tropical de São Paulo |
repository.name.fl_str_mv |
Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT) |
repository.mail.fl_str_mv |
||revimtsp@usp.br |
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1798951636643610624 |