CD4:CD8 Ratio and Non-AIDS Defining Events in Virally Suppressed HIV Infected Patients: Need to Look Beyond CD4+ T-Cell Counts
Antiretroviral therapy has led to improvement in life-expectancy through
viral suppression and improved immune status. This brings in the concern about
the non-AIDS defining illnesses which are mostly age associated such as cardiovascular disease,
stroke, renal disease, liver disease, neurocognitive disorders, and non-AIDS malignancies.
These are reported to be present at comparatively younger ages in HIV-infected patients.
It also raises questions on the usefulness of CD4 T cell counts in patients with
full HIV RNA suppression.
CD4 count remains the most important predictor of clinical progression
in people with HIV infection, but it does not predict immune activation
in chronic HIV infection and non-AIDS illnesses.
Several immunological alterations characteristic of HIV infection,
such as immune activation and inflammation, are similar
to the immunological alterations associated with normal aging.
This finding has led to an intersection of the fields of aging and HIV disease,
especially with regard to immune alterations. Inversion of the CD4:CD8
ratio has been identified as a hallmark of immuno senescence and
an independent predictor of all-cause mortality in the general population.
This information has prompted the evaluation of the CD4:CD8 ratio as a surrogate marker
for the risk of morbidity and mortality in HIV-positive people in the current
era of Antiretroviral therapy.
Immune activation in HIV infected, marked by levels of circulating markers of innate
immune activation is widely accepted as the major driving factor of immunosenescence.
Since persistent immune activation in treated HIV infection drives non-AIDS-associated diseases,
CD4:CD8 could be a marker for long lasting immune activation despite ART
HIV/AIDS Res Treat Open J. 2015; 2(1): e12-e15. doi: 10.17140/HARTOJ-2-e005
