Coinfection by Hepatitis C Is Strongly Associated with Abnormal CD4CD8 Ratio in HIV Patients under Stable ART in Salvador, Brazil

Abstract EN

Proper immune restoration (CD4 count >500 and normal CD4/8 ratio) is reached only by a fraction of HIV patients, despite stable viral suppression.

Methods.

We present a case-control study to compare HIV patients with viral suppression >1 year, according to immune restoration pattern: adequate response (AR) defined by CD4 > 500 cells/mm3 and CD4/8 ratio >1; partial response (PR = patients with CD4 > 500, but CD4/8 ratio <1); inadequate response (IR = CD4 < 500 cells).

Results.

We evaluated 293 consecutive patients (89 AR, 112 PR, and 92 IR), 70% males.

Male gender ( p < 0.01 ), lower mean CD4 nadir ( p < 0.001 ), higher baseline VL ( p = 0.01 ), previous diagnosis of Tb ( p = 0.03 ), or HCV ( p < 0.01 ) was associated with IR.

Likelihood of AR/PR was similar regardless of gender, after adjusting for nadir CD4+ cells count.

Longer time under suppressive ART was also associated with a greater chance of AR, but logistic regression identified coinfection by HCV as the main factor associated with abnormal CD4/CD8 ratio.

Conclusion.

Early initiation of ART and longer time since first undetectable PVL were predictors of AR.

Previous HCV diagnosis significantly increases the risk of abnormal CD4/CD8 ratio.