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19 juin 2018
- doi: 10.1097/QAD.0000000000001848
- issn: 0269-9370
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info:eu-repo/semantics/altIdentifier/doi/10.1097/QAD.0000000000001848
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info:eu-repo/semantics/altIdentifier/pmid/29851663
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info:eu-repo/semantics/altIdentifier/eissn/1473-5571
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info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_B55B1D6552053
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R.A. Hughes et al., « Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+ : CD8+ ratio. », Serveur académique Lausannois, ID : 10.1097/QAD.0000000000001848
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Model trajectories of CD4+ and CD8+ cell counts after starting combination antiretroviral therapy (ART) and use the model to predict trends in these counts and the CD4+ : CD8+ ratio. Cohort study of antiretroviral-naïve HIV-positive adults who started ART after 1997 (ART Cohort Collaboration) with more than 6 months of follow-up data. We jointly estimated CD4+ and CD8+ cell count trends and their correlation using a bivariate random effects model, with linear splines describing their population trends, and predicted the CD4+ : CD8+ ratio trend from this model. We assessed whether CD4+ and CD8+ cell count trends and the CD4+ : CD8+ ratio trend varied according to CD4+ cell count at start of ART (baseline), and, whether these trends differed in patients with and without virological failure more than 6 months after starting ART. A total of 39 979 patients were included (median follow-up was 53 months). Among patients with baseline CD4+ cell count at least 50 cells/μl, predicted mean CD8+ cell counts continued to decrease between 3 and 15 years post-ART, partly driving increases in the predicted mean CD4+ : CD8+ ratio. During 15 years of follow-up, normalization of the predicted mean CD4+ : CD8+ ratio (to >1) was only observed among patients with baseline CD4+ cell count at least 200 cells/μl. A higher baseline CD4+ cell count predicted a shorter time to normalization. Declines in CD8+ cell count and increases in CD4+ : CD8+ ratio occurred up to 15 years after starting ART. The likelihood of normalization of the CD4+ : CD8+ ratio is strongly related to baseline CD4+ cell count.