Objective: Antiretroviral therapy (ART) decreases HIV viral replication leading to CD4+ recovery, decreased CD8+ expansion and CD4+/CD8+ ratio recovery. We investigated factors associated with impaired recovery of CD4+ and CD4+/CD8+ ratios among people with HIV (PWH) maintaining HIV viral suppression. Design/methods: PWH ≥18 years accessing the Southern Alberta Clinic between 01/01/1998-01/06/2022 entered the study at time of HIV viral suppression (50 years old vs. <30 years old (aHR: 0.59 0.46-0.77). Females were more likely to recover both CD4+ (aHR: 1.421.18–1.71) and CD4+/CD8+ ratios (aHR: 1.561.25–1.95) compared with males. Both higher baseline CD4+ counts and CD4+/CD8+ ratios were associated with greater immune recovery. ART regimen at study entry impacted CD4+ but not CD4+/CD8+ ratio recovery. CMV coinfection was associated with reduced CD4+/CD8+ ratio recovery (aHR: 0.47 0.37–0.62). Conclusions: While most PWH with ongoing viral suppression will recover their CD4+ cell counts, recovery of CD4+/CD8+ ratio recovery is less common, indicating ongoing immune dysfunction. Several demographic and clinical factors are associated with impaired immune recovery. Further characterization and understanding of the long-term impact of impaired immune recovery is needed.
Al-Yasiri et al. (Thu,) studied this question.