This article is available in: PDF HTML EPUB XML

CD4/CD8 ratio is not predictive of multi-morbidity prevalence in HIV-infected patients but identify patients with higher CVD risk

Marianna Menozzi, Stefano Zona, Antonella Santoro, Federica Carli, Chiara Stentarelli, Cristina Mussini, Giovanni Guaraldi

Abstract


Background: CD4/CD8<0.8 is a surrogate marker of immuneactivation/immunosenescence and independently predicts mortality in the HIV infected patients (pts) due to non-AIDS related events. Most studies showed that pts on ART often fail to normalize the CD4/CD8 ratio despite CD4 count normalization. Primary objective of the study was to explore the impact of CD4/CD8<0.8 as independent predictor of HIV associated non AIDS (HANA) conditions and multimorbidity (MM) in HIV pts. In pts with no previous history of cardiovascular disease (CVD) a particular insight is provided in the association between impact of CD4/CD8<0.8 and risk prediction of CVD or radiological markers of subclinical CVD.

Material and methods: 914 consecutive pts attending Modena Metabolic HIV Clinic were evaluated in a cross sectional retrospective study. Inclusion criteria: stable ART from >=2years; HIV RNA plasma levels<40 copies/ml; stable CD4 count>=350/mmc. CD4/CD8 strata (0.8) was chosen as a cut off representing the median value of the cohort. MM was defined as the presence of >=2 HANA conditions including standard defined: chronic kidney disease, hypertension, previous CVD events, osteoporosis and diabetes mellitus. Calendar year of ART initiation was defined: "PreART" (<2000); "EarlyART" (2000-2005) and "LateART" (>=2006). High CVD risk was defined for Framingham Risk Score (FRS)>=6. Subclinical CVD was defined using cardiac CT scan for calcium score (CAC)>=100. Logistic univariate and multivariable adjusted analysis were performed to assess relationships between variables.

Results: Demographic and HIV specific variables distribution in pts with and without MM are shown in Table 1. Figure 1 shows HANA distribution across CD4/CD8 strata: CVD prevalence only appeared to be higher in patients with no CD4/CD8>0.8. In multivariable analyses CD4/CD8<0.8 was not an independent predictor of MM (OR=1.225, CI:0.891; 1.681, p=0.211) after adjustment for age, gender and BMI. Pts with CD4/CD8<0.8 displayed higher CVD risk but not higher prevalence of subclinical CVD. At multivariable analyses CD4/CD8<0.8 remained predictor of higher CVD risk (OR=0.65 CI 0.47-0.917, p=0.014) after correction for sex, bmi, age strata and HIV infection duration.

Conclusions: Low CD4/CD8 ratio was not associated with MM prevalence. Pts with CD4/CD8<0.8 ratio displayed higher prevalence of CVD. At multivariable logistic regression CD4/CD8<0.8 is an independent prepredictor of enhanced CVD risk. This may support role of immune-activation/senescence in the pathogenesis of CVD.

(Published: 2 November 2014)

Citation: Menozzi M et al. Journal of the International AIDS Society 2014, 17(Suppl 3):19709

http://www.jiasociety.org/index.php/jias/article/view/19709 | http://dx.doi.org/10.7448/IAS.17.4.19709




Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Journal of the International AIDS Society | eISSN 1758-2652 | Editors-in-Chief: Susan Kippax and Kenneth Mayer

*2016 Journal Citation Reports® Science Edition - a Clarivate Analytics product.

Disclaimer: The Journal of the International AIDS Society is an official journal of and is published by the International AIDS Society. The costs of the Journal of the International AIDS Society are secured by the International AIDS Society. This support does not in any way affect the editorial independency of the Journal of the International AIDS Society. Material published in the journal is entirely independent of the opinion of external sponsors and the society.