Association Between CD4/CD8 Ratio Recovery and Chronic Kidney Disease Among Human Immunodeficiency Virus-Infected Patients Receiving Antiretroviral Therapy: A 17-Year Observational Cohort Study.

Fengxiang Qin,Junjun Jiang,Rongfeng Chen,Hao Liang,Ke Lan,Li Ye,Di Wei,Bingyu Liang,Kui Huang,Jie Liu,Wen Hong,Shanfang Qin,Qing Lv,Huayue Liang

doi:10.3389/fmicb.2022.827689

Abstract

Background:CD4/CD8 ratio is considered as an emerging biomarker for human immunodeficiency virus (HIV)-related diseases. However, the relationship of CD4/CD8 ratio recovery and chronic kidney disease (CKD), and whether cumulative antiretroviral therapy (ART) is effective in the CD4/CD8 ratio recovery and in reducing CKD incidence among HIV patients remain unclear.MethodsA 17-year observational cohort study was conducted on all HIV-infected patients receiving ART in Guangxi, China. Kaplan–Meier analysis was used to investigate the cumulative CKD incidence. Cox regression and propensity score matching (PSM) were used to evaluate the association between CD4/CD8 ratio recovery and CKD incidence, and the effect of ART regimens on CD4/CD8 ratio recovery and CKD incidence.ResultsA total of 59,268 eligible individuals contributing 285,143 person-years of follow-up, with an overall CKD incidence of 9.65%. After ART, patients who developed CKD showed higher mortality than those with normal kidney function (12.48 vs. 7.57%, p < 0.001). Patients whose CD4/CD8 ratio did not recover to 0.7 had a higher CKD incidence than the patients who recovered (aHR = 2.84, 95% CI 2.63–3.07), similar to the PSM analysis (aHR = 3.13, 95% CI 2.85–3.45). Compared with the PI-based and INSTI-based regimens, NNRTI-based regimen had a better CD4/CD8 ratio recovery rate (27.04, 16.16, and 29.66%, respectively) and a lower CKD incidence (17.43, 16.16, and 7.31%, respectively).ConclusionThis large-scale real-world setting provide new evidence that the CD4/CD8 ratio recovery is associated with lower CKD incidence in HIV-infected patients receiving ART. NNRTI-based is a better choice for CD4/CD8 ratio recovery and reducing the risk of CKD.

Highlights

Antiretroviral therapy (ART) has significantly decreased the mortality of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients
No significant difference was seen in the nucleoside reverse transcriptase inhibitor (NNRTI)-based group. This is a real-world study with a 17-year observation period and a large sample size that was conducted on HIV-positive individuals in Guangxi, China to explore the relationship of the CD4/CD8 ratio recovery and chronic kidney disease (CKD)
Our study showed that patients with CKD had a higher risk of death, which is consistent with the results of previous research, indicating that kidney disease can significantly increase the risk of death in HIV-infected individuals (Sarfo et al, 2013; Mallipattu et al, 2014)

Summary

Introduction

Antiretroviral therapy (ART) has significantly decreased the mortality of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients. Previous studies have shown that diabetes, hypertension, and chronic kidney disease (CKD) are important NCDs among HIV patients (Kooij et al, 2017; Mathabire Rucker et al, 2018; Sutton et al, 2019). The kidney plays an important role in drug metabolism and excretion, and its function or deficiency thereof is more evident in HIV-infected patients receiving long-term ART. The Guangxi Zhuang Autonomous Region, located in western China, suffers a high burden of HIV infection, with more than 110,000 HIV patients receiving ART in 2020. The relationship of CD4/CD8 ratio recovery and chronic kidney disease (CKD), and whether cumulative antiretroviral therapy (ART) is effective in the CD4/CD8 ratio recovery and in reducing CKD incidence among HIV patients remain unclear

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Conclusion