People living with HIV on an integrase inhibitor (INSTI)-based regimen showed better CD4/CD8 ratio recovery than those on an NNRTI- or PI-based regimen, according to the results of a large observational cohort study in Canada. The results held true regardless of whether or not a person was on their first antiretroviral regimen.
About This Study
“CD4/CD8 ratio outcome according to the class of the third active drug in antiretroviral therapy (ART) regimens: results from the Quebec Human Immunodeficiency Virus (HIV) Cohort Study” was published online on Feb. 1, 2023, in Clinical Infectious Diseases. The lead author is Mohamed N’dongo Sangaré of Université du Québec en Abitibi-Témiscamingue in Rouyn-Noranda, Canada.
Key Research Findings
The study authors stated that there is a dearth of data on the impact of different therapeutic classes of ART on the CD4/CD8 ratio, a marker of inflammation. The aim of this multicenter cohort study, with a large sample size and long follow-up period, was to compare various regimens of ART with the normalization of CD4/CD8 ratio.
Data came from 3,907 participants in the observational Quebec HIV Cohort who took two nucleoside reverse transcriptase inhibitors plus a non-nucleoside reverse transcriptase inhibitor (25% of participants), a protease inhibitor (51% of participants) or an integrase strand transfer inhibitor (24% of participants). The starting point for all data used in the study was Aug. 31, 2017.
The cohort included ART-naïve PLWH (n=1,041), as well as those who switched to one of these regimens (n=2,866). Total follow-up time was 13,640 person-years, at a mean follow-up of 4.8 years.
At study inclusion, most participants were me; mean age was 43 years; and mean time on ART was 4 to 5 years (depending on regimen). Baseline viral suppression rates ranged from 31% in the NNRTI group to 25% in the PI group and 23% in the INSTI group.
At study entry, 9% of participants in the NNRTI group, 5% of participants in the PI group, and 8% of participants in the INSTI group had a CD4/CD8 ratio > 1, with median ratios of 0.4, 0.3, and 0.4, respectively for the three groups. After a median 4 years on their respective regimens, 13% of all participants had a CD4/CD8 ratio ≥ 1, with 14% of people in the NNRTI group, 10% of those in the PI group and 20% of participants in the INSTI group achieving that ratio. Results were similar for participants who had been ART-naïve or ART-exposed at inclusion.
The better CD4/CD8 ratio recovery in the INSTI group seemed to be driven by an increase in CD4 cells rather than a drop in CD8 cells, the study authors observed. Within that group, participants on elvitegravir or dolutegravir had better CD4/CD8 recovery than those on raltegravir.
Discussion Highlights and Implications for Practice
The study authors asserted that normalizing the CD4/CD8 ratio is important for reducing morbidity among PLWH, and stated that their study findings suggest that INSTIs appear to be better at achieving this outcome than NNRTIs or PIs.