Low CD4/CD8 ratio is associated with increased morbidity and mortality in late and non-late presenters : results from a multicentre cohort study, 2004-2018
Domínguez-Domínguez, Lourdes (Hospital Universitario 12 de Octubre (Madrid))
Rava, Marta (CIBER de Enfermedades Infecciosas)
Bisbal, Otilia (Hospital Universitario 12 de Octubre (Madrid))
Lopez-Cortés, Luis (Instituto de Biomedicina de Sevilla)
Portilla, Joaquín (Hospital General Universitario de Alicante (Alacant, País Valencià))
Podzamczer, Daniel (Hospital Universitari de Bellvitge)
Olalla, Julián (Hospital Costa del Sol (Marbella))
Fuster, Daniel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Rubio, Rafael (CIBER de Enfermedades Infecciosas)
Jarrín, Inmaculada (CIBER de Enfermedades Infecciosas)
Iribarren, José Antonio (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Moreno, Santiago (Instituto Ramón y Cajal de Investigación Sanitaria (Madrid))
Universitat Autònoma de Barcelona

Fecha:	2022
Resumen:	To study whether the association between the CD4/CD8 ratio variation over time and the development of clinical outcomes vary in late presenters (CD4 count < 350/µL or AIDS event at enrolment) or advanced presenters (CD4 count < 200/µL or AIDS event at enrolment). We included ART-naïve adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) enrolled between January 2004 up to November 2018 and with at least 6 months of follow-up. We used extended Cox proportional hazard models to estimate the hazard ratios (HRs) for the association between CD4/CD8 ratio over time and a composite endpoint of the occurrence of the first AIDS event, first serious non-AIDS event or overall mortality occurring from 6 months after enrolment. HRs in non-late, late and advanced presenters were obtained by including an interaction term between late presentation status and CD4/CD8 ratio over time. Of 10,018 participants, 55. 6% were late presenters and 26. 5% were advanced presenters. Compared with CD4/CD8 ratio > 0. 4, CD4/CD8 ratio ≤ 0. 4 over time was associated with an increased risk of experiencing the composite endpoint in non-late (HR 1. 90; 95%CI 1. 48, 2. 43), late (HR 1. 94; 1. 46, 2. 57) and advanced presenters (HR 1. 72; 1. 26, 2. 34). Similarly, CD4/CD8 ratio ≤ 0. 4 over time was associated with a higher risk of developing an AIDS event (HR 3. 31; 2. 23, 4. 93 in non-late; HR 2. 75; 1. 78, 4. 27 in late and HR 2. 25; 1. 34, 3. 76 in advanced presenters) or serious non-AIDS event (HR 1. 39; 0. 96, 2. 02 in non-late, HR 1. 62; 1. 10, 2. 40 in late and HR 1. 49; 0. 97, 2. 29 in advanced presenters) as well as with a higher risk of overall mortality (HR 1. 49; 0. 92, 2. 41 in non-late, HR 1. 80; 1. 04, 3. 11 in late and HR 1. 61; 0. 92, 2. 83 in advanced presenters) compared to CD4/CD8 > 0. 4, regardless of the late presentation status. A low CD4/CD8 measured over time is associated with increased risk of morbidity and mortality in people living with HIV independently of their late presentation status. These data support the prognostic role of CD4/CD8 over time and can help defining a subgroup of patients who need closer monitoring to avoid comorbidities. The online version contains supplementary material available at 10. 1186/s12879-022-07352-z.
Ayudas:	Instituto de Salud Carlos III RD06/006 Instituto de Salud Carlos III RD12/0017/0018 Instituto de Salud Carlos III RD16/0002/0006
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Late presentation ; CD4/CD8 ; Clinical outcomes ; AIDS events ; Serious non-AIDS events ; Mortality
Publicado en:	BMC Infectious diseases, Vol. 22 (april 2022) , art. 379, ISSN 1471-2334

DOI: 10.1186/s12879-022-07352-z
PMID: 35428209

10 p, 795.8 KB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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