Abstract
Background and Objectives Variations in immune reconstitution following antiretroviral treatment (ART) among HIV patients have previously been observed. This study aims at assessing immune reconstitution after successful ART among HIV-infected Saudi patients. Methods This retrospective study of 240 HIV-infected patients was performed between May 2010 and June 2015 in the HIV center at King Saud Hospital, Riyadh. Data were extracted for CD4, CD8 cell, and CD3/HLA-DR counts along with the viral load from patient records before and after four years of successful ART. The inclusion criterion was patients with CD4 reconstitution of either equal to or more than 400 cells/mm3 with an undetectable HIV viral load following ART. Based on their presentation, the HIV patients were grouped into early treatment (ET) and delayed treatment (DT) groups with CD4 counts of 200–350 cells/mm3 and less than 200 cells/mm3, respectively. Findings The pretreatment CD8+ counts of median 865 cells/mm3 (interquartile range (IQR) 774–1072) in the DT group declined to median 753 cells/mm3 (IQR 574–987; p < 0.0001). Moreover, there was a decline in CD8 counts from 703 cells/mm3 (IQR 655–747) to 620 cells/mm3 (IQR 563–645; p < 0.04) in the ET group after four years of successful ART. Pretreatment activation marker (CD3/HLA-DR+) expression of median 29% in the DT group declined to 22% and in the ET group from a median of 23% to 19% after treatment. The CD4/CD8 ratio in the DT group increased from 0.14 (IQR 0.09–0.88) to 0.71 (IQR 0.54–0.9) and from 0.42 (IQR 0.35–0.55) to 0.87 (IQR 0.71–0.98) in the ET group. Conclusion Immune reconstitution after successful ART among HIV-infected Saudi patients was associated with a CD8 T-cell population expansion with a suboptimal CD4/CD8 ratio and persistent immune activation. Early initiation of ART appears to favorably influence the CD4/CD8 ratio.
Highlights
Human immunodeficiency virus-1 (HIV-1) infection is characterized by gradual CD4 depletion, CD8 expansion, and immune activation [1]
Despite the successful restoration of CD4 counts and human immunodeficiency virus (HIV) suppression following antiretroviral treatment (ART), immune activation tends to persist, and CD8 counts seldom normalize [4]. ere is an emerging consensus that persistent immune activation and inflammation are due to residual HIV replication and microbial translocation that contributes to CD8 expansion [5]
It has recently been shown that a low CD4/CD8 ratio inversely correlates with the risk of morbidity and mortality [9, 10, 12]. e aim of this study was to assess the immune reconstitution after four years of successful treatment with ART in an Asian population-based cohort of HIV-infected individuals
Summary
Human immunodeficiency virus-1 (HIV-1) infection is characterized by gradual CD4 depletion, CD8 expansion, and immune activation [1]. During the course of illness among patients with human immunodeficiency virus (HIV) infection, CD4+ T-cell counts and viral load are traditionally monitored in order to assess response to therapeutic intervention. It has been observed that the reversed CD4/CD8 ratio tends to persist among individuals with an undetectable HIV viral load and CD4 T-cell counts of more than 500 cell/ml [9, 10]. E aim of this study was to assess the immune reconstitution after four years of successful treatment with ART in an Asian population-based cohort of HIV-infected individuals. Data for CD4, CD8, CD4/CD8, and CD3+/HLA-DR counts and HIV viral load before initiation of ART and four years after successful ART were extracted from the patients’ medical record. During the four years of ART, each patient underwent three monthly assessments for cell counts and HIV RNA. Comparisons between groups were performed using the Mann–Whitney U test. p < 0.05 was considered statistically significant
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