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CD4/CD8 Ratio Recovery Among People Living With HIV Starting With First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis

Han WM 1 , Avihingsanon A 2 , Rajasuriar R 3 , Tanuma J 4 , Mundhe S 5 , Lee MP 6 Show all authors , Choi JY 7 , Pujari S 8 , Chan YJ 9 , Somia A 10 , Zhang F 11 , Kumarasamy N 12 , Tek Ng O 13 , Gani Y 14 , Chaiwarith R 15 , Pham TN 16 , Do CD 17 , Ditangco R 18 , Kiertiburanakul S 19 , Khol V 20 , Ross J 21 , Jiamsakul A 1 , IeDEA Asia‐Pacific

Affiliations 

  • 1 The Kirby Institute, UNSW Sydney, NSW, Australia
  • 2 HIV-NAT/Thai Red Cross AIDS Research Centre and Centre of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 3 Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 4 National Center for Global Health and Medicine, Tokyo, Japan
  • 5 BJ Government Medical College and Sassoon General Hospital, Pune, India
  • 6 Queen Elizabeth Hospital, Hong Kong SAR
  • 7 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 8 Institute of Infectious Diseases, Pune, India
  • 9 Taipei Veterans General Hospital, Taipei, Taiwan
  • 10 Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
  • 11 Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 12 CART CRS, Voluntary Health Services, Chennai, India
  • 13 Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore
  • 14 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 15 Chiang Mai University - Research Institute for Health Sciences, Chiang Mai, Thailand
  • 16 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 17 Bach Mai Hospital, Hanoi, Vietnam
  • 18 Research Institute for Tropical Medicine, Muntinlupa City, Philippines
  • 19 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 20 National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia; and
  • 21 TREAT Asia, AmfAR - the Foundation for AIDS Research, Bangkok, Thailand
J Acquir Immune Defic Syndr, 2023 Feb 01;92(2):180-188.
PMID: 36625858 DOI: 10.1097/QAI.0000000000003121

Abstract

BACKGROUND: We evaluated trends in CD4/CD8 ratio among people living with HIV (PLWH) starting antiretroviral therapy (ART) with first-line integrase strand transfer inhibitors (INSTI) compared with non-INSTI-based ART, and the incidence of CD4/CD8 ratio normalization.

METHODS: All PLWH enrolled in adult HIV cohorts of IeDEA Asia-Pacific who started with triple-ART with at least 1 CD4, CD8 (3-month window), and HIV-1 RNA measurement post-ART were included. CD4/CD8 ratio normalization was defined as a ratio ≥1. Longitudinal changes in CD4/CD8 ratio were analyzed by linear mixed model, the incidence of the normalization by Cox regression, and the differences in ratio recovery by group-based trajectory modeling.

RESULTS: A total of 5529 PLWH were included; 80% male, median age 35 years (interquartile range [IQR], 29-43). First-line regimens were comprised of 65% NNRTI, 19% PI, and 16% INSTI. The baseline CD4/CD8 ratio was 0.19 (IQR, 0.09-0.33). PLWH starting with NNRTI- (P = 0.005) or PI-based ART (P = 0.030) had lower CD4/CD8 recovery over 5 years compared with INSTI. During 24,304 person-years of follow-up, 32% had CD4/CD8 ratio normalization. After adjusting for age, sex, baseline CD4, HIV-1 RNA, HCV, and year of ART initiation, PLWH started with INSTI had higher odds of achieving CD4/CD8 ratio normalization than NNRTI- (P < 0.001) or PI-based ART (P = 0.015). In group-based trajectory modeling analysis, INSTI was associated with greater odds of being in the higher ratio trajectory.

CONCLUSIONS: INSTI use was associated with higher rates of CD4/CD8 ratio recovery and normalization in our cohort. These results emphasize the relative benefits of INSTI-based ART for immune restoration.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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