Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug 28;20(1):31.
doi: 10.1186/s12865-019-0311-2.

The predictive role of CD4+ cell count and CD4/CD8 ratio in immune reconstitution outcome among HIV/AIDS patients receiving antiretroviral therapy: an eight-year observation in China

Chong-Xi Li  1   2 , Yu-Ye Li  3   4 , Li-Ping He  5 , Jing Kou  6   7 , Jin-Song Bai  2 , Jun Liu  2 , Bo Tian  2 , Li-Juan Cao  1 , Kun-Hua Wang  8 , Yi-Qun Kuang  9   10
Affiliations

The predictive role of CD4+ cell count and CD4/CD8 ratio in immune reconstitution outcome among HIV/AIDS patients receiving antiretroviral therapy: an eight-year observation in China

Chong-Xi Li et al. BMC Immunol. .

Abstract

Background: The immune reconstitution after initiation of highly active antiretroviral therapy (HAART) among HIV-infected individuals substantially affects patients' prognosis. However, the dynamic characteristics and predictors of reconstitution outcome remain unclear.

Methods: In this study, the HIV/AIDS patients with sustained virological suppression (viral load < 50 copies/ml) after HAART were enrolled. The patients were subgrouped into immunological non-responders (INRs) (< 200 cells/μl), immunological inadequate responders (IIRs) (200 ~ 500 cells/μl) and immunological responders (IRs) (> 500 cells/μl) according to the CD4 cell count after two-year HAART. The immune reconstitution data based on the CD4+ and CD8+ cell counts with 8-year follow-up were collected for analysis.

Results: The CD4+ cell counts in the immunological responders (IRs) were significantly higher than in the immunological non-responders (INRs) and immunological inadequate responders (IIRs) (P < 0.001). The overall CD4+ cell count and CD4/CD8 ratio in the IRs increased faster than the IIRs and INRs. The CD4+ cell count growth at 0.5 year and 1 year after HAART in the IRs was significantly higher than the IIRs and INRs. The ROC curve demonstrated that 1 year CD4+ cell count had the highest predictive value, with the best cut-off value of 188 cells/μl, the predictive sensitivity was 81.0%, the predictive specificity was 85.2%, false positive rate was 14.8%, false negative rate was 19.0%, positive predictive value (IR) was 63.0%, negative predictive value (INR) was 93.5%.

Conclusions: Taken together, our findings suggest that early initiation of HAART can reduce the immune reconstitution failure. The combination of baseline CD4+ cell count and baseline CD4/CD8 ratio may serve as a valid predictor of immune reconstitution prognosis after HAART.

Keywords: Clinical predictor; HAART; HIV/AIDS; Immune reconstitution; Prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The characteristics of immune reconstitution in three groups. (a) The dynamics of CD4 cell counts at different time-points (from 0 ~ 8 years). (b) The dynamics of CD4 cell count growth at different time-points (from 0.5 ~ 8 years). (c) The dynamics of CD4/CD8 ratios at different time-points (from 0 ~ 8 years). (d) The dynamics of CD4/CD8 ratio growth at different time-points (from 0.5 ~ 8 years). The data are presented with median ± SE. The black cycles indicate the INRs, the red squares depict the IIRs, and the blue triangles indicate the IRs
Fig. 2
Fig. 2
The ROC cure of predictive indexes. The X-axis depicts the specificity of predictor, the Y-axis indicates the sensitivity of the predictor. The diagonal line is the reference
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. The lancet HIV 2017. - PMC - PubMed
    1. Pakker NG, Kroon ED, Roos MT, Otto SA, Hall D, Wit FW, Hamann D, van der Ende ME, Claessen FA, Kauffmann RH, et al. Immune restoration does not invariably occur following long-term HIV-1 suppression during antiretroviral therapy. INCAS Study Group. AIDS. 1999;13(2):203–212. doi: 10.1097/00002030-199902040-00008. - DOI - PubMed
    1. Autran B, Carcelain G, Li TS, Blanc C, Mathez D, Tubiana R, Katlama C, Debre P, Leibowitch J. Positive effects of combined antiretroviral therapy on CD4+ T cell homeostasis and function in advanced HIV disease. Science. 1997;277(5322):112–116. doi: 10.1126/science.277.5322.112. - DOI - PubMed
    1. Saison J, Ferry T, Demaret J, Maucort-Boulch D, Venet F, Perpoint T, Ader F, Icard V, Chidiac C, Monneret G. Relationship between discordant response to HAART, Tregs, immune activation and low-level viraemia. J Int AIDS Soc. 2014;17(4 Suppl 3):19672. doi: 10.7448/IAS.17.4.19672. - DOI - PMC - PubMed
    1. Frater J, Ewings F, Hurst J, Brown H, Robinson N, Fidler S, Babiker A, Weber J, Porter K, Phillips RE. HIV-1-specific CD4(+) responses in primary HIV-1 infection predict disease progression. AIDS. 2014;28(5):699–708. doi: 10.1097/QAD.0000000000000130. - DOI - PubMed

Publication types

MeSH terms