CD4/CD8 ratio in pregnant women with HIV and its association with pregnancy outcome: data from a national study in Italy.
CD4
CD4/CD8 ratio
CD8
HIV suppression
Pregnancy
Preterm delivery
Journal
Infection
ISSN: 1439-0973
Titre abrégé: Infection
Pays: Germany
ID NLM: 0365307
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
08
02
2021
accepted:
26
04
2021
pubmed:
9
5
2021
medline:
26
11
2021
entrez:
8
5
2021
Statut:
ppublish
Résumé
To evaluate associations between CD4/CD8 ratio and pregnancy outcomes in women with HIV. We evaluated, in a national study of pregnant women with HIV receiving antiretroviral treatment (ART), values of CD4/CD8 ratio at entry in pregnancy, changes between first and third trimester, and possible associations with preterm delivery, low birthweight, and HIV-RNA < 50 copies/ml at third trimester in univariate and multivariate analyses. Among 934 women, 536 (57.4%) were already on ART at conception. CD4/CD8 ratio (baseline value 0.570) increased significantly between the first and third trimesters, particularly in women who started ART in pregnancy (+ 0.163, vs. + 0.036 in women already on treatment). The rate of CD4/CD8 ratio normalization, defined by achieving a ratio ≥ 1 at the third trimester, was 13.2%. In multivariable analyses, women who entered pregnancy with a CD4/CD8 ratio < 0.3, compared to women with ratio ≥ 1, were almost four-times less likely to have third-trimester HIV-RNA < 50 copies/ml (AOR 0.258, 95%CI 0.111-0.601), and more than twice as likely to have preterm delivery (AOR 2.379, 95%CI 1.082-5.232). For preterm delivery, also a baseline CD4/CD8 ratio between 0.3 and 0.45 was significantly associated with an increased risk (AOR: 3.415, 95%CI 1.690-6.900). We described for the first time independent associations of low CD4/CD8 ratio with preterm delivery and HIV-RNA suppression.
Identifiants
pubmed: 33963983
doi: 10.1007/s15010-021-01619-4
pii: 10.1007/s15010-021-01619-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
955-964Subventions
Organisme : Agenzia Italiana del Farmaco, Ministero della Salute
ID : H85E08000200005
Investigateurs
M Floridia
(M)
M Ravizza
(M)
E Tamburrini
(E)
M Ravizza
(M)
E Tamburrini
(E)
F Di Lorenzo
(F)
G Sterrantino
(G)
M Meli
(M)
I Campolmi
(I)
F Vichi
(F)
B Del Pin
(B)
R Marocco
(R)
C Mastroianni
(C)
V S Mercurio
(VS)
D Zanaboni
(D)
G Guaraldi
(G)
G Nardini
(G)
C Stentarelli
(C)
B Beghetto
(B)
A M Degli Antoni
(AM)
A Molinari
(A)
M P Crisalli
(MP)
A Donisi
(A)
A Ruggieri
(A)
M Piepoli
(M)
V Cerri
(V)
G Zuccotti
(G)
V Giacomet
(V)
L Paradiso
(L)
F Forlanini
(F)
E Longoni
(E)
G Placido
(G)
P Milini
(P)
F Savalli
(F)
F Sabbatini
(F)
D Francisci
(D)
C Papalini
(C)
L Bernini
(L)
P Grossi
(P)
L Rizzi
(L)
V Portelli
(V)
G Maso
(G)
M Bernardon
(M)
S Bussolaro
(S)
I Della Pietà
(I)
A Sorz
(A)
A Meloni
(A)
A Chiodo
(A)
M Dedoni
(M)
F Ortu
(F)
P Piano
(P)
A Citernesi
(A)
I Bordoni Vicini
(I)
K Luzi
(K)
A Spinillo
(A)
M Roccio
(M)
A Vimercati
(A)
D Calabretti
(D)
S Gigante
(S)
B Guerra
(B)
F Cervi
(F)
G Simonazzi
(G)
E Margarito
(E)
M G Capretti
(MG)
C Marsico
(C)
G Faldella
(G)
M Sansone
(M)
P Martinelli
(P)
A Agangi
(A)
A Capone
(A)
G M Maruotti
(GM)
C Tibaldi
(C)
L Trentini
(L)
T Todros
(T)
G Masuelli
(G)
V Frisina
(V)
V Savasi
(V)
E Cardellicchio
(E)
C Giaquinto
(C)
M Fiscon
(M)
E Rubino
(E)
L Franceschetti
(L)
R Badolato
(R)
M A Forleo
(MA)
B Tassis
(B)
M Ruggiero
(M)
O Genovese
(O)
C Cafforio
(C)
C Pinnetti
(C)
G Liuzzi
(G)
A M Casadei
(AM)
A F Cavaliere
(AF)
M Cellini
(M)
A M Marconi
(AM)
S Dalzero
(S)
M Ierardi
(M)
S C Simonetti
(SC)
N Alfieri
(N)
S Agrati
(S)
C Polizzi
(C)
A Mattei
(A)
M F Pirillo
(MF)
R Amici
(R)
C M Galluzzo
(CM)
S Donnini
(S)
S Baroncelli
(S)
M Floridia
(M)
A Cerioli
(A)
M De Martino
(M)
F Parazzini
(F)
E Tamburrini
(E)
S Vella
(S)
P Martinelli
(P)
M Ravizza
(M)
Informations de copyright
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Caby F. Writing committee of the CD4+/CD8+ Ratio Working Group of the French Hospital Database on HIV (FHDH-ANRS CO4). CD4+/CD8+ ratio restoration in long-term treated HIV-1-infected individuals. AIDS. 2017;31:1685–95.
doi: 10.1097/QAD.0000000000001533
Chereau F, Madec Y, Sabin C, Obel N, Ruiz-mateos E, Chrysos G, et al. Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers. PLoS ONE. 2017;12:e0173893.
doi: 10.1371/journal.pone.0173893
Davy-Mendez T, Napravnik S, Zakharova O, Kuruc J, Gay C, Hicks CB, et al. Acute HIV infection and CD4/CD8 ratio normalization after antiretroviral therapy initiation. J Acquir Immune Defic Syndr. 2018;79:510–8.
doi: 10.1097/QAI.0000000000001843
Francis-Morris A, Mackie NE, Eliahoo J, Ramzan F, Fidler S, Pollock KM. Compromised CD4:CD8 ratio recovery in people living with HIV aged over 50 years: an observational study. HIV Med. 2020;21:109–18.
doi: 10.1111/hiv.12800
Han WM, Apornpong T, Kerr SJ, Hiransuthikul A, Gatechompol S, Do T, et al. CD4/CD8 ratio normalization rates and low ratio as prognostic marker for non-AIDS defining events among long-term virologically suppressed people living with HIV. AIDS Res Ther. 2018;15:13.
doi: 10.1186/s12981-018-0200-4
Hughes RA, May MT, Tilling K, Taylor N, Wittkop L, Reiss P, et al. Long terms trends in CD4+ cell counts, CD8+ cell counts, and the CD4+ : CD8+ ratio. AIDS. 2018;32:1361–7.
doi: 10.1097/QAD.0000000000001848
Lee SS, Wong NS, Wong BCK, Wong KH, Chan KCW. Combining CD4 recovery and CD4: CD8 ratio restoration as an indicator for evaluating the outcome of continued antiretroviral therapy: an observational cohort study. BMJ Open. 2017;7:e016886.
doi: 10.1136/bmjopen-2017-016886
Milanés-Guisado Y, Gutiérrez-Valencia A, Trujillo-Rodríguez M, Espinosa N, Viciana P, López-Cortés LF. Absolute CD4+ T cell count overstate immune recovery assessed by CD4+/CD8+ ratio in HIV-infected patients on treatment. PLoS ONE. 2018;13:e0205777.
doi: 10.1371/journal.pone.0205777
Mussini C, Lorenzini P, Cozzi-Lepri A, Lapadula G, Marchetti G, Nicastri E, et al. CD4/CD8 ratio normalisation and non-AIDS-related events in individuals with HIV who achieve viral load suppression with antiretroviral therapy: an observational cohort study. Lancet HIV. 2015;2:e98-106.
doi: 10.1016/S2352-3018(15)00006-5
Castilho JL, Turner M, Shepherd BE, Koethe GR, Furukawa SS, Bofill CE, et al. CD4/CD8 ratio and CD4 Nadir predict mortality following noncommunicable disease diagnosis in adults living with HIV. AIDS Res Hum Retroviruses. 2019;35:960–7.
doi: 10.1089/aid.2019.0064
Hansen S, Kronborg G, Benfield T. Prediction of liver disease, AIDS, and mortality based on discordant absolute and relative peripheral CD4 T lymphocytes in HIV/Hepatitis C Virus-coinfected individuals. AIDS Res Hum Retroviruses. 2018;34:1058–66.
doi: 10.1089/aid.2017.0058
Trickey A, May MT, Schommers P, Tate J, Ingle SM, Guest JL, et al. CD4:CD8 ratio and CD8 count as prognostic markers for mortality in human immunodeficiency virus-infected patients on antiretroviral therapy: the antiretroviral therapy cohort collaboration (ART-CC). Clin Infect Dis. 2017;65:959–66.
doi: 10.1093/cid/cix466
Gojak R, Hadžiosmanović V, Baljić R, Zečević L, Ćorić J, Mijailović Ž. CD4/CD8 ratio as a predictor for the occurrence of metabolic syndrome in HIV/AIDS patients during 6 months of cART therapy. J Med Biochem. 2019;38:489–95.
doi: 10.2478/jomb-2018-0049
Focà E, Magro P, Guaraldi G, Riva A, Cattelan AM, De Socio GV, et al. Elderly HIV-positive women: a gender-based analysis from the Multicenter Italian “GEPPO” Cohort. PLoS ONE. 2019;14:e0222225.
doi: 10.1371/journal.pone.0222225
Serrano-Villar S, Caruana G, Zlotnik A, Pérez-Molina JA, Moreno S. Effects of Maraviroc versus Efavirenz in combination with Zidovudine-Lamivudine on the CD4/CD8 ratio in treatment-naive HIV-infected individuals. Antimicrob Agents Chemother. 2017;61:pii: e01763-17.
doi: 10.1128/AAC.01763-17
Xiao PL, Zhou YB, Chen Y, Yang MX, Song XX, Shi Y, et al. Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies. BMC Pregnancy Childbirth. 2015;15:246.
doi: 10.1186/s12884-015-0684-z
Floridia M, Mastroiacovo P, Tamburrini E, Tibaldi C, Todros T, Crepaldi A, et al. Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011. BJOG. 2013;120:1466–75.
doi: 10.1111/1471-0528.12285
Ministero della Salute – Sistema Nazionale per le linee guida. Linee guida per la gravidanza fisiologica. Aggiornamento 2011. https://www.epicentro.iss.it/itoss/pdf/gravidanza%20fisiologica_allegato.pdf . Accessed 9 Dec 2020.
Kotz D, Fidler J, West R. Very low rate and light smokers: smoking patterns and cessation-related behaviour in England, 2006–11. Addiction. 2012;107:995–1002.
doi: 10.1111/j.1360-0443.2011.03739.x
Floridia M, Ravizza M, Masuelli G, Tassis B, Savasi VM, Liuzzi G, et al. Prevalence, correlates and outcomes of smoking in pregnant women with HIV: a national observational study in Italy. Subst Use Misuse. 2020;55:1165–72.
doi: 10.1080/10826084.2020.1729204
Bertino E, Spada E, Occhi L, Coscia A, Giuliani F, Gagliardi L, et al. Neonatal anthropometric charts: the Italian neonatal study compared with other European studies. J Pediatr Gastroenterol Nutr. 2010;51:353–61.
doi: 10.1097/MPG.0b013e3181da213e
Wang L, Zhao H, Cai W, Tao J, Zhao Q, Sun L, et al. Risk factors associated with preterm delivery and low delivery weight among HIV-exposed neonates in China. Int J Gynaecol Obstet. 2018;142:300–7.
doi: 10.1002/ijgo.12532
Sebikari D, Farhad M, Fenton T, Owor M, Stringer JSA, Qin M, et al. Risk factors for adverse birth outcomes in the PROMISE 1077BF/1077FF trial. J Acquir Immune Defic Syndr. 2019;81:521–32.
doi: 10.1097/QAI.0000000000002072
Huang Q-T, Huang Q, Zhong M, Wei SS, Luo W, Li F, et al. Chronic hepatitis C virus infection is associated with increased risk of preterm birth: a meta-analysis of observational studies. J Viral Hepat. 2015;22:1033–42.
doi: 10.1111/jvh.12430
Floridia M, Ravizza M, Pinnetti C, Tibaaldi C, Bucceri A, Anzidei G, et al. Treatment change in pregnancy is a significant risk factor for detectable HIV-1 RNA in plasma at end of pregnancy. HIV Clin Trials. 2010;11:303–11.
doi: 10.1310/hct1106-303
Floridia M, Dalzero S, Giacomet V, Tamburrini E, Masuelli G, Savasi V, et al. Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors: an observational study. Infection. 2020;48:249–58.
doi: 10.1007/s15010-019-01384-5
Green ES, Arck PA. Pathogenesis of preterm birth: bidirectional inflammation in mother and fetus. Semin Immunopathol. 2020;42:413–29.
doi: 10.1007/s00281-020-00807-y
Fiore S, Newell M-L, Trabattoni D, Thorne C, Gray L, Savasi V, et al. Antiretroviral therapy-associated modulation of Th1 and Th2 immune responses in HIV-infected pregnant women. J Reprod Immunol. 2006;70:143–50.
doi: 10.1016/j.jri.2005.12.001
Tsonis O, Gkrozou F, Harrison E, Stefanidis K, Vrachnis N, Paschopoulos M. Female genital tract microbiota affecting the risk of preterm birth: What do we know so far? A review. Eur J Obstet Gynecol Reprod Biol. 2020;245:168–73.
doi: 10.1016/j.ejogrb.2019.12.005
Taguchi A, Yamashita A, Kawana K, Nagamatsu T, Furuya H, Inoue E, et al. Recent progress in therapeutics for inflammation-associated preterm birth: a review. Reprod Sci. 2017;24:7–18.
doi: 10.1177/1933719115618282
Chudnovets A, Liu J, Narasimhan H, Liu Y, Burd I. Role of inflammation in virus pathogenesis during pregnancy. J Virol. 2020; 95(2):e01381–19. https://doi.org/10.1128/JVI.01381-19 .
doi: 10.1128/JVI.01381-19
pubmed: 33115865
pmcid: 7944452