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Portilla-Tamarit J, Fuster-RuizdeApodaca MJ, Portilla-Tamarit I, Reus S, Riera M, Espinosa N, Martín J, Bernal E, Masia M, Calzado S, Portilla J. Long-Term Health-Related Quality of Life in People Living with HIV Who Present to Care with AIDS or Severe Immunodeficiency: The CoRIS AIDS Survivors Study. AIDS Behav 2025:10.1007/s10461-025-04730-x. [PMID: 40369301 DOI: 10.1007/s10461-025-04730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2025] [Indexed: 05/16/2025]
Abstract
Our aim was to evaluate long-term health-related quality of life (HRQoL) in 253 people living with HIV (PLH) from the CoRIS cohort presenting to care with advanced HIV disease (AIDS or CD4 ≤ 100 cells/µL) and who had survived ≥ 5 years. Participants completed the WHOQOL-HIV-BREF and EQ-5D-5 L questionnaires. Clinical and immunological data were provided by the CoRIS at enrollment and on questionnaire completion. Linear repeated measures analyses assessed the evolution of immunological markers. Partial least squares structural equation modeling showed the longitudinal impact of baseline immunological markers on HRQoL. High baseline CD4 counts predicted higher WHOQOL-HIV-BREF independence scores (p = 0.021) and a marginally higher EQ-5D-5 L index value (p = 0.058), which was also associated with CD8 (p = 0.015). A higher CD4/CD8 ratio predicted lower scores on the WHOQOL-HIV-BREF 'spirituality, religion and personal belief' dimension (p = 0.006). Currently, PLH who present with advanced HIV disease achieve a moderate long-term HRQoL, with room for improvement.
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Affiliation(s)
- Julia Portilla-Tamarit
- Infectious Diseases Unit and Internal Medicine Department, University General Hospital Dr, Balmis, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
| | | | - Irene Portilla-Tamarit
- Infectious Diseases Unit and Internal Medicine Department, University General Hospital Dr, Balmis, Alicante, Spain.
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain.
- Department of Health Psychology, University of Alicante, San Vicente del Raspeig Street, CP 03690, San Vicente, Alicante, Spain.
| | - Sergio Reus
- Infectious Diseases Unit and Internal Medicine Department, University General Hospital Dr, Balmis, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Clinical Medicine Department, Miguel Hernandez University, Elche, Alicante, Spain
| | - Melchor Riera
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Son Espases University Hospital, Palma de Mallorca, Spain
| | - Nuria Espinosa
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Clinical Unit of Infectious Diseases, Clinical Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital, CSIC/University of Seville, Seville , Spain
| | - Juan Martín
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- 12th of October University Hospital, Madrid, Spain
| | - Enrique Bernal
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Clinical Medicine Department, Miguel Hernandez University, Elche, Alicante, Spain
- Reina Sofía Hospital, Murcia, Spain
| | - Mar Masia
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- University General Hospital of Elche, Elche, Spain
| | - Sonia Calzado
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- University Hospital Parc Taulí, Sabadell, Spain
| | - Joaquín Portilla
- Infectious Diseases Unit and Internal Medicine Department, University General Hospital Dr, Balmis, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Clinical Medicine Department, Miguel Hernandez University, Elche, Alicante, Spain
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Chaves YO, Gama WM, Reis MFD, Baptista BJA, Almeida TVR, Balieiro AADS, Costa AGD, Ibiapina HNDS, Carvalho ATD, Xavier TDS, Melo MMD, Pinheiro RDS, Souza JMD, Salimo ZM, Filho OAM, Lacerda MVGD, Benzaken AS, Ferreira LCDL, Nogueira PA. Association between cytokine and increased risk of death in ART- naïve and ART-non-adherence patients hospitalized with advanced HIV disease. BMC Infect Dis 2025; 25:197. [PMID: 39924485 PMCID: PMC11808995 DOI: 10.1186/s12879-024-10260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 11/22/2024] [Indexed: 02/11/2025] Open
Abstract
BACKGROUND Despite progress in healthcare for people living with HIV/AIDS (PLWHA), many still present with advanced HIV, thus increasing their risk of death. Late initiation of treatment and poor adherence to antiretroviral therapy (ART) are key contributing factors. This study aimed to evaluate cytokines as mortality predictors among hospitalized PLWHA. It assessed the risk of death between ART-naïve and ART-non-adherent PLWHA with advanced HIV and quantified immunological markers in post-mortem samples to determine the influence of irregular ART use. METHODS A longitudinal observational study was conducted at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) in Manaus, Brazil, with 111 participants recruited between 2018 and 2019. Clinical and laboratory data were obtained from electronic medical records. Plasma samples were analyzed for 27 cytokines/chemokines using the Luminex® multiplex assay within 72 h of admission and 6 h after post-mortem. RESULTS ART-naïve PLWHA had a higher risk of death. Most of the 27 immunological markers analyzed in the post-mortem were elevated in those who died compared to those who were discharged. Increased levels of IFNγ, CCL2, and CCL3 were associated with death. Elevated immunological markers in ART-naïve PLWHA correlated with CD4 cell counts. Notably, IL-17 increased in ART-naïve PLWHA, while IL-2 increased in ART-non-adherent PLWHA, indicating a dichotomy. T helper-2 responses were marked by IL-9 in ART-naïve and IL-5 in ART-non-adherent PLWHA. CONCLUSIONS ART-naïve PLWHA hospitalized with advanced HIV have a higher risk of death. Some immunological markers are possible predictors of death upon hospital admission due to HIV/AIDS, and their levels were found to be increased in post-mortem blood samples. Our findings suggest a polarized response among ART-naïve and ART-non-adherent PLWHA.
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Affiliation(s)
- Yury Oliveira Chaves
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Amazonas, 69020-160, Brazil
- Laboratório de Diagnóstico e Controle de Doenças Infecciosas na Amazônia (DCDIA), Instituto Leônidas e Maria Deane (ILMD)- Fiocruz Amazônia, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Biologia da Relação Patógeno-Hospedeiro, Fundação Oswaldo Cruz-Instituto Leônidas e Maria Deane, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-graduação em Ciências Aplicadas à Hematologia, PPGH-UEA/HEMOAM, Manaus, Amazonas, 69050-001, Brazil
| | - Wellington Mota Gama
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus, Amazonas, 69080-900, Brazil
| | - Monique Freire Dos Reis
- Departamento de Patologia e Medicina Legal, Universidade Federal do Amazonas, Manaus, Amazonas, 69020-160, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, 69040-000, Brazil
| | - Bárbara José Antunes Baptista
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Amazonas, 69020-160, Brazil
| | - Taynná Vernalha Rocha Almeida
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Amazonas, 69020-160, Brazil
| | - Antônio Alcirley da Silva Balieiro
- Programa de Pós-Graduação em Biologia da Relação Patógeno-Hospedeiro, Fundação Oswaldo Cruz-Instituto Leônidas e Maria Deane, Manaus, Amazonas, 69057-070, Brazil
| | - Allyson Guimarães da Costa
- Programa de Pós-graduação em Ciências Aplicadas à Hematologia, PPGH-UEA/HEMOAM, Manaus, Amazonas, 69050-001, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus, Amazonas, 69080-900, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, 69040-000, Brazil
| | | | - Andrea Teixeira de Carvalho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo - Fiocruz Minais Gerais, Belo Horizonte, Minas Gerais, 30190-002, Brazil
| | - Thaissy Dos Santos Xavier
- Laboratório de Diagnóstico e Controle de Doenças Infecciosas na Amazônia (DCDIA), Instituto Leônidas e Maria Deane (ILMD)- Fiocruz Amazônia, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Biologia da Relação Patógeno-Hospedeiro, Fundação Oswaldo Cruz-Instituto Leônidas e Maria Deane, Manaus, Amazonas, 69057-070, Brazil
| | - Marly Marques de Melo
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69057-070, Brazil
| | - Rebeca de Souza Pinheiro
- Laboratório de Diagnóstico e Controle de Doenças Infecciosas na Amazônia (DCDIA), Instituto Leônidas e Maria Deane (ILMD)- Fiocruz Amazônia, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, 69040-000, Brazil
| | - Jhennyffer Mendes de Souza
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo - Fiocruz Minais Gerais, Belo Horizonte, Minas Gerais, 30190-002, Brazil
| | - Zeca Manuel Salimo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, 69040-000, Brazil
| | - Olindo Assis Martins Filho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo - Fiocruz Minais Gerais, Belo Horizonte, Minas Gerais, 30190-002, Brazil
| | - Marcus Vinícius Guimarães de Lacerda
- Programa de Pós-Graduação em Biologia da Relação Patógeno-Hospedeiro, Fundação Oswaldo Cruz-Instituto Leônidas e Maria Deane, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69057-070, Brazil
| | - Adele Schwartz Benzaken
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, 69040-000, Brazil
- AIDS Healthcare Foundation (AHF), Los Angeles, CA, 90028, USA
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Amazonas, 69020-160, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69057-070, Brazil
| | - Paulo Afonso Nogueira
- Laboratório de Diagnóstico e Controle de Doenças Infecciosas na Amazônia (DCDIA), Instituto Leônidas e Maria Deane (ILMD)- Fiocruz Amazônia, Manaus, Amazonas, 69057-070, Brazil.
- Programa de Pós-Graduação em Biologia da Relação Patógeno-Hospedeiro, Fundação Oswaldo Cruz-Instituto Leônidas e Maria Deane, Manaus, Amazonas, 69057-070, Brazil.
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus, Amazonas, 69080-900, Brazil.
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Ron R, Martínez-Sanz J, Herrera S, Ramos-Ruperto L, Díez-Vidal A, Sainz T, Álvarez-Díaz N, Correa-Pérez A, Muriel A, López-Alcalde J, Pérez-Molina JA, Moreno S, Serrano-Villar S. CD4/CD8 ratio and CD8+ T-cell count as prognostic markers for non-AIDS mortality in people living with HIV. A systematic review and meta-analysis. Front Immunol 2024; 15:1343124. [PMID: 38361925 PMCID: PMC10868578 DOI: 10.3389/fimmu.2024.1343124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Background In people living with HIV (PLHIV), the CD4/CD8 ratio has been proposed as a useful marker for non-AIDS events. However, its predictive ability on mortality over CD4 counts, and the role of CD8+ T-cell counts remain controversial. Methods We conducted a systematic review and meta-analysis of published studies from 1996 to 2023, including PLHIV on antiretroviral treatment, and reporting CD4/CD8 ratio or CD8+ counts. The primary outcome was non-AIDS mortality or all-cause mortality. We performed a standard random-effects pairwise meta-analysis comparing low versus high CD4/CD8 ratio with a predefined cut-off point of 0.5. (CRD42020170931). Findings We identified 2,479 studies for screening. 20 studies were included in the systematic review. Seven studies found an association between low CD4/CD8 ratio categories and increased mortality risk, with variable cut-off points between 0.4-1. Four studies were selected for meta-analysis, including 12,893 participants and 618 reported deaths. Patients with values of CD4/CD8 ratio below 0.5 showed a higher mortality risk (OR 3.65; 95% CI 3.04 - 4.35; I2 = 0.00%) compared to those with higher values. While the meta-analysis of CD8+ T-cell counts was not feasible due to methodological differences between studies, the systematic review suggests a negative prognostic impact of higher values (>1,138 to 1,500 cells/uL) in the long term. Conclusions Our results support the use of the CD4/CD8 ratio as a prognostic marker in clinical practice, especially in patients with values below 0.5, but consensus criteria on ratio timing measurement, cut-off values, and time to event are needed in future studies to get more robust conclusions. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020170931, identifier CRD42020170931.
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Affiliation(s)
- Raquel Ron
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá (UAH), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sabina Herrera
- Infectious Diseases Department, Hospital Clinic, Barcelona, Spain
| | - Luis Ramos-Ruperto
- HIV Unit, Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - Alejandro Díez-Vidal
- HIV Unit, Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - Talía Sainz
- Pediatric Tropical and Infectious Diseases, Hospital la Paz and La Paz Research Institute (IdiPAZ), Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Universidad Autoónoma de Madrid, UAM, Madrid, Spain
| | - Noelia Álvarez-Díaz
- Medical Library, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Andrea Correa-Pérez
- Faculty of Medicine, Universidad Francisco de Vitoria (UFV), Madrid, Spain
- Pharmacy and Medical Devices Department. Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alfonso Muriel
- Universidad de Alcalá (UAH), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jesús López-Alcalde
- Faculty of Medicine, Universidad Francisco de Vitoria (UFV), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - José A. Pérez-Molina
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá (UAH), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá (UAH), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá (UAH), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Borker PV, Macatangay BJ, Margolick JB, Punjabi NM, Rinaldo CR, Stosor V, Hyong-Jin Cho J, McKay H, Patel SR. Shorter total sleep time is associated with lower CD4+/CD8+ T cell ratios in virally suppressed men with HIV. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae001. [PMID: 38420256 PMCID: PMC10901437 DOI: 10.1093/sleepadvances/zpae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/06/2023] [Indexed: 03/02/2024]
Abstract
Study Objectives Although poor sleep quality is associated with lower CD4+ T cell counts among people living with HIV (PLWH), the association between objective sleep metrics and T lymphocyte subset counts is unknown. We evaluated the association between polysomnography (PSG) derived sleep metrics and T lymphocyte subpopulations in a cohort of men living with HIV. Methods Virally suppressed men living with HIV participating in the Multicenter AIDS Cohort Study underwent home overnight PSG. We assessed the association of PSG parameters with CD4+ and CD8+ T cell counts and the CD4+/CD8+ T cell ratio. Results Overall, 289 men with mean (±SD) age 55.3 ± 11.3 years and mean CD4+ T cell count 730 ± 308 cells/mm3 were evaluated. Total sleep time (TST) was significantly associated with CD8+ but not CD4+ T cell counts. After adjusting for age, race, depressive symptoms, antidepressant use, and non-nucleoside reverse transcriptase inhibitors use, every hour of shorter TST was associated with an additional 33 circulating CD8+ T cells/mm3 (p = 0.05) and a 5.6% (p = 0.0007) decline in CD4+/CD8+ T cell ratio. In adjusted models, every hour of shorter rapid eye movement (REM) sleep was associated with an additional 113 CD8+ T cells/mm3 (p = 0.02) and a 15.1% lower CD4+/CD8+ T cell ratio (p = 0.006). In contrast, measures of sleep efficiency and sleep-disordered breathing were not associated with differences in T lymphocyte subpopulations. Conclusions Our findings suggest that shorter TST and REM sleep durations are associated with differences in T lymphocyte subpopulations among men living with HIV. Addressing sleep may reflect a novel opportunity to improve immune function in PLWH.
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Affiliation(s)
- Priya V Borker
- Division of Pulmonary Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, PAUSA
| | | | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naresh M Punjabi
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Charles R Rinaldo
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PAUSA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University, Chicago, IL, USA
| | - Joshua Hyong-Jin Cho
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CAUSA
| | - Heather McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sanjay R Patel
- Division of Pulmonary Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, PAUSA
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Suanzes P, Navarro J, Rando-Segura A, Álvarez-López P, García J, Descalzo V, Monforte A, Arando M, Rodríguez L, Planas B, Burgos J, Curran A, Buzón MJ, Falcó V. Impact of very early antiretroviral therapy during acute HIV infection on long-term immunovirological outcomes. Int J Infect Dis 2023; 136:100-106. [PMID: 37726066 DOI: 10.1016/j.ijid.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/26/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES We aimed to determine if starting antiretroviral therapy (ART) in the first 30 days after acquiring HIV infection has an impact on immunovirological response. METHODS Observational, ambispective study including 147 patients with confirmed acute HIV infection (January/1995-August/2022). ART was defined as very early (≤30 days after the estimated date of infection), early (31-180 days), and late (>180 days). We compared time to viral suppression (viral load [VL] <50 copies/ml) and immune recovery (IR) (CD4+/CD8+ ratio ≥1) according to the timing and type of ART using survival analysis. RESULTS ART was started in 140 (95.2%) patients. ART was very early in 24 (17.1%), early in 77 (55.0%), and late in 39 (27.9%) cases. Integrase strand transfer inhibitor (INSTI)-based regimens were the most used in both the overall population (65%) and the very early ART group (23/24, 95.8%). Median HIV VL and CD4+/CD8+ ratio pre-ART were higher in the very early ART group (P <0.05). Patients in the very early and early ART groups and treated with INSTI-based regimens achieved IR earlier (P <0.05). Factors associated with faster IR were the CD4+/CD8+ ratio pre-ART (hazard ratio: 9.3, 95% CI: 3.1-27.8, P <0.001) and INSTI-based regimens (hazard ratio: 2.4, 95% CI: 1.3-4.2, P = 0.003). CONCLUSIONS The strongest predictors of IR in patients who start ART during AHI are the CD4+/CD8+ ratio pre-ART and INSTI-based ART regimens.
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Affiliation(s)
- Paula Suanzes
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Navarro
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Ariadna Rando-Segura
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Patricia Álvarez-López
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jorge García
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Vicente Descalzo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Arnau Monforte
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maider Arando
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lucía Rodríguez
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Bibiana Planas
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Joaquín Burgos
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Adrian Curran
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - María José Buzón
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Martínez-Sanz J, Díaz-Álvarez J, Rosas M, Ron R, Iribarren JA, Bernal E, Gutiérrez F, Ruiz Sancho A, Cabello N, Olalla J, Moreno S, Serrano-Villar S. Expanding HIV clinical monitoring: the role of CD4, CD8, and CD4/CD8 ratio in predicting non-AIDS events. EBioMedicine 2023; 95:104773. [PMID: 37639938 PMCID: PMC10474064 DOI: 10.1016/j.ebiom.2023.104773] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND While a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear. METHODS We analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events. FINDINGS The study included 4625 participants, 83% male, of whom 200 (4.3%) experienced an SNAE during the follow-up period. A CD4/CD8 ratio <0.3 predicted an increased risk of SNAEs during the next five years (OR 1.63, 95% CI 1.03-2.58). The effect was stronger at a CD4/CD8 ratio cut-off of <0.2 (OR 3.09, 95% CI 1.57-6.07). Additionally, low CD4 count at cut-offs of <500 cells/μL predicted an increased risk of clinical events. Among participants with a CD4 count ≥500 cells/μL, a CD8 count ≥1500 cells/μL or a CD4/CD8 ratio <0.4 predicted increased SNAE risk. INTERPRETATION Our results support the use of the CD4/CD8 ratio and CD8 count as predictors of clinical progression. Patients with CD4/CD8 ratio <0.3 or CD8 count ≥1500/μL, regardless of their CD4 count, may benefit from closer monitoring and targeted preventive interventions. FUNDING This work was supported by CIBER (CB 2021), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU; by the Spanish AIDS Research Network (RIS) RD16/0025/0001 project as part of the Plan Nacional R + D + I, and cofinanced by Instituto de Salud Carlos III (ISCIII)- Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER), ISCIII projects PI18/00154, PI21/00141, and ERDF, "A way to make Europe", ICI20/00058.
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Affiliation(s)
- Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jorge Díaz-Álvarez
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Rosas
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Ron
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Iribarren
- Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastián, Spain
| | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Félix Gutiérrez
- Hospital General Universitario de Elche & Universidad Miguel Hernández, Alicante, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Noemi Cabello
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Santiago Moreno
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; University of Alcalá, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Liu B, Li K, Li S, Zhao R, Zhang Q. The association between the CD4/CD8 ratio and surgical site infection risk among HIV-positive adults: insights from a China hospital. Front Immunol 2023; 14:1135725. [PMID: 37497209 PMCID: PMC10366603 DOI: 10.3389/fimmu.2023.1135725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023] Open
Abstract
Purpose It is well known that the CD4/CD8 ratio is a special immune-inflammation marker. We aimed to explore the relationship between the CD4/CD8 ratio and the risk of surgical site infections (SSI) among human immunodeficiency virus (HIV)-positive adults undergoing orthopedic surgery. Methods We collected and analyzed data from 216 HIV-positive patients diagnosed with fractures at the department of orthopedics, Beijing Ditan Hospital between 2011 and 2019. The demographic, surgical, and hematological data for all patients were collected in this retrospective cohort study. We explored the risk factors for SSI using univariate and multivariate logistic regression analysis. Then, the clinical correlation between the CD4 count, CD4/CD8 ratio, and SSI was studied using multivariate logistic regression models after adjusting for potential confounders. Furthermore, the association between the CD4/CD8 ratio and SSI was evaluated on a continuous scale with restricted cubic spline (RCS) curves based on logistic regression models. Results A total of 23 (10.65%) patients developed SSI during the perioperative period. Patients with hepatopathy (OR=6.10, 95%CI=1.46-28.9), HIV viral load (OR=8.68, 95%CI=1.42-70.2; OR=19.4, 95%CI=3.09-179), operation time (OR=7.84, 95%CI=1.35-77.9), and CD4 count (OR=0.05, 95%CI=0.01-0.23) were risk factors for SSI (P-value < 0.05). Our study demonstrated that a linear relationship between CD4 count and surgical site infection risk. In other words, patients with lower CD4 counts had a higher risk of developing SSI. Furthermore, the relationship between CD4/CD8 ratio and SSI risk was non-linear, inverse 'S' shaped. The risk of SSI increased substantially when the ratio was below 0.913; above 0.913, the risk of SSI was almost unchanged. And there is a 'threshold-saturation' effect between them. Conclusion Our research shows the CD4/CD8 ratio could be a useful predictor and immune-inflammation marker of the risk of SSI in HIV-positive fracture patients. These results, from a Chinese hospital, support the beneficial role of immune reconstitution in HIV-positive patients prior to orthopedic surgery.
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