Brief Report: Enhanced Normalization of CD4/CD8 Ratio with Earlier Antiretroviral Therapy at Primary HIV Infection

John Thornhill, Jamie Inshaw, Pontiano Kaleebu, David Cooper, Gita Ramjee, Mauro Schechter, Giuseppe Tambussi, Julie Fox, Miriam Samuel, Jose M. Miro, Jonathan Weber, Kholoud Porter, Sarah Fidler

Research output: Contribution to journalArticlepeer-review


Background: Total CD4 + T-cell counts predict HIV disease progression but do not necessarily reflect normalization of immune function. CD4/CD8 ratio is a marker of immune dysfunction, a prognostic indicator for non-AIDS mortality, and reflects viral reservoir size. Despite antiretroviral therapy (ART), recovery of CD4/CD8 ratio in chronic HIV infection is incomplete; we hypothesize enhanced CD4/CD8 ratio recovery with earlier treatment initiation in recently infected individuals. Methods: CD4 + count and CD4/CD8 ratio were analyzed using data from 2 cohorts: SPARTAC trial and the UK HIV Seroconverters Cohort where primary HIV infection (PHI) was defined as within 6 months from estimated date of infection. Using time-to-event methods and Cox proportional hazard models, we examined the effect of CD4/CD8 ratio at seroconversion on disease progression (CD4 1.0). Findings: Of 573 seroconverters, 482 (84%) had abnormal CD4/CD8 ratios at HIV seroconversion. Individuals with higher CD4/CD8 ratio at seroconversion were significantly less likely to reach the disease progression endpoint [adjusted hazard ratio (aHR) (95% CI) 0.52 (0.32 to 0.82), P 0.005]. The longer the interval between seroconversion and ART initiation [HR (95% CI) 0.98 per month increase (0.97, 0.99), P <0.001], the less likely the CD4/CD8 ratio normalization. ART initiation within 6 months from seroconversion was significantly more likely to normalize [HR (95% CI) 2.47 (1.67 to 3.67), P <0.001] than those initiating later. Interpretation: Most individuals presenting in PHI have abnormal CD4/CD8 ratios. The sooner the ART is initiated in PHI, the greater the probability of achieving normal CD4/CD8 ratio.
Original languageEnglish
Pages (from-to)69 - 73
Number of pages5
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number1
Publication statusPublished - Sep 1 2016


  • acute HIV infection
  • CD4/CD8 ratio
  • CD4:CD8
  • early antiretroviral therapy
  • primary HIV infection
  • seroconversion

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases


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