Prognostic factors of a lower CD4/CD8 ratio in long term viral suppression HIV infected children

Guillen, S. ; Prieto, L. ; de Ory, S.J. ; Gonzalez-Tome, M.I. ; Rojo, P. ; Navarro, M.L. ; Mellado, M.J. ; Escosa, L. ; Sainz, T. ; Francisco, L. ; Munoz-Fernandez, M.A. ; Ramos, J.T. ; Hortelano, M.G. ; Blazquez, D. ; Epalza, C. ; Saavedra, J. ; Santos, M. ; Munoz, M.A. ; Santiago, B. ; Carrasco, I. ; Roa, M.A. ; Beceiro, J. ; Penin, M. ; Martinez, J. ; Badillo, K. ; Apilanez, M. ; Pocheville, I. ; Garrote, E. ; Colino, E. ; Sirvent, J.G. ; Garzon, M. ; Roman, V. ; Munoz, M.J. ; Angulo, R. ; Neth, O. ; Falcon, L. ; Terol, P. ; Santos, J.L. ; Moreno, D. ; Lendinez, F. ; Peromingo, E. ; Montero, M. ; Grande, A. ; Romero, F.J. ; Perez, C. ; Martinez, M. ; Lillo, M. ; Losada, B. ; Herranz, M. ; Bustillo, M. ; Guerrero, C. ; Collado, P. (Universidad de Zaragoza) ; Couceiro, J.A. ; Vila, L. ; Calvino, C. ; Piqueras, A.I. ; Breton, R. ; Oltra, M. ; Lopez, E. ; Segarra, I. ; Gavilan, C. ; Montesinos, E. ; Dapena, M. ; Alvarez, C. ; Jimenez, B. ; Andres, A.G. ; Marugan, V. ; Ochoa, C. ; Alfayate, S. ; Menasalvas, A.I. ; del Prado, Y.R. ; Soler-Palacin, P. ; Frick, M.A. ; Mur, A. ; Lopez, N. ; Mendez, M. ; Mayol, L. ; Vallmanya, T. ; Calavia, O. ; Garcia, L. ; Pineda, V. ; Rius, N. ; Duenas, J. ; Fortuny, C. ; Noguera-Julian, A.

Resumen: Background
Combination antiretroviral therapy (cART) is associated with marked immune reconstitution. Although a long term viral suppression is achievable, not all children however, attain complete immunological recovery due to persistent immune activation. We use CD4/CD8 ratio like a marker of immune reconstitution.
Methods
Perinatal HIV-infected children who underwent a first-line cART, achieved viral suppression in the first year and maintained it for more than 5 years, with no viral rebound were included. Logistic models were applied to estimate the prognostic factors, clinical characteristics at cART start, of a lower CD4/CD8 ratio at the last visit.
Results
146 HIV-infected children were included: 77% Caucasian, 45% male and 28% CDC C. Median age at cART initiation was 2.3 years (IQR: 0.5-6.2). 42 (30%) children received mono-dual therapy previously to cART. Time of undetectable viral load was 9.5 years (IQR: 7.8, 12.5). 33% of the children not achieved CD4/CD8 ratio >1. Univariate analysis showed an association between CD4/CD8 <1 with lower CD4 nadir and baseline CD4; older age at diagnosis and at cART initiation; and a previous exposure to mono-dual therapy. Multivariate analysis also revealed relationship between CD4/CD8 <1 and lower CD4 nadir (OR: 1.002, CI 95% 1.000-1.004) as well as previous exposure to mono-dual therapy (OR: 0.16, CI 95% 0.003-0.720).
Conclusions
CD4/CD8 > 1 was not achieved in 33% of the children. Lower CD4 nadir and previous exposure to suboptimal therapy, before initiating cART, are factors showing independently association with a worse immune recovery (CD4/CD8 < 1).

Idioma: Inglés

DOI: 10.1371/journal.pone.0220552

Año: 2019

Publicado en: PloS one 14, 8 (2019), e0220552[11 pp]
ISSN: 1932-6203

Factor impacto JCR: 2.74 (2019)

Categ. JCR: MULTIDISCIPLINARY SCIENCES rank: 27 / 71 = 0.38 (2019) - Q2 - T2

Factor impacto SCIMAGO: 1.023 - Multidisciplinary (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Pediatría (Dpto. Pediatría Radiol.Med.Fís)