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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


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 |

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