CD4/CD8 Ratio and the Risk of Kaposi Sarcoma or Non-Hodgkin Lymphoma in the Context of Efficiently Treated Human Immunodeficiency Virus (HIV) Infection: A Collaborative Analysis of 20 European Cohort Studies.
CD4/CD8 ratio
CD8 T-cells
Kaposi sarcoma
efficient cART
non-Hodgkin lymphoma
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
received:
08
03
2020
accepted:
03
08
2020
entrez:
9
8
2021
pubmed:
10
8
2021
medline:
23
9
2021
Statut:
ppublish
Résumé
A persistently low CD4/CD8 ratio has been reported to inversely correlate with the risk of non-AIDS defining cancer in people living with human immunodeficiency virus (HIV; PLWH) efficiently treated by combination antiretroviral therapy (cART). We evaluated the impact of the CD4/CD8 ratio on the risk of Kaposi sarcoma (KS) or non-Hodgkin lymphoma (NHL), still among the most frequent cancers in treated PLWH. PLWH from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) were included if they achieved virological control (viral load ≤ 500 copies/mL) within 9 months following cART and without previous KS/LNH diagnosis. Cox models were used to identify factors associated with KS or NHL risk, in all participants and those with CD4 ≥ 500/mm3 at virological control. We analyzed the CD4/CD8 ratio, CD4 count and CD8 count as time-dependent variables, using spline transformations. We included 56 708 PLWH, enrolled between 2000 and 2014. At virological control, the median (interquartile range [IQR]) CD4 count, CD8 count, and CD4/CD8 ratio were 414 (296-552)/mm3, 936 (670-1304)/mm3, and 0.43 (0.28-0.65), respectively. Overall, 221 KS and 187 NHL were diagnosed 9 (2-37) and 18 (7-42) months after virological control. Low CD4/CD8 ratios were associated with KS risk (hazard ratio [HR] = 2.02 [95% confidence interval {CI } = 1.23-3.31]) when comparing CD4/CD8 = 0.3 to CD4/CD8 = 1) but not with NHL risk. High CD8 counts were associated with higher NHL risk (HR = 3.14 [95% CI = 1.58-6.22]) when comparing CD8 = 3000/mm3 to CD8 = 1000/mm3). Similar results with increased associations were found in PLWH with CD4 ≥ 500/mm3 at virological control (HR = 3.27 [95% CI = 1.60-6.56] for KS; HR = 5.28 [95% CI = 2.17-12.83] for NHL). Low CD4/CD8 ratios and high CD8 counts despite effective cART were associated with increased KS/NHL risks respectively, especially when CD4 ≥ 500/mm3.
Sections du résumé
BACKGROUND
A persistently low CD4/CD8 ratio has been reported to inversely correlate with the risk of non-AIDS defining cancer in people living with human immunodeficiency virus (HIV; PLWH) efficiently treated by combination antiretroviral therapy (cART). We evaluated the impact of the CD4/CD8 ratio on the risk of Kaposi sarcoma (KS) or non-Hodgkin lymphoma (NHL), still among the most frequent cancers in treated PLWH.
METHODS
PLWH from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) were included if they achieved virological control (viral load ≤ 500 copies/mL) within 9 months following cART and without previous KS/LNH diagnosis. Cox models were used to identify factors associated with KS or NHL risk, in all participants and those with CD4 ≥ 500/mm3 at virological control. We analyzed the CD4/CD8 ratio, CD4 count and CD8 count as time-dependent variables, using spline transformations.
RESULTS
We included 56 708 PLWH, enrolled between 2000 and 2014. At virological control, the median (interquartile range [IQR]) CD4 count, CD8 count, and CD4/CD8 ratio were 414 (296-552)/mm3, 936 (670-1304)/mm3, and 0.43 (0.28-0.65), respectively. Overall, 221 KS and 187 NHL were diagnosed 9 (2-37) and 18 (7-42) months after virological control. Low CD4/CD8 ratios were associated with KS risk (hazard ratio [HR] = 2.02 [95% confidence interval {CI } = 1.23-3.31]) when comparing CD4/CD8 = 0.3 to CD4/CD8 = 1) but not with NHL risk. High CD8 counts were associated with higher NHL risk (HR = 3.14 [95% CI = 1.58-6.22]) when comparing CD8 = 3000/mm3 to CD8 = 1000/mm3). Similar results with increased associations were found in PLWH with CD4 ≥ 500/mm3 at virological control (HR = 3.27 [95% CI = 1.60-6.56] for KS; HR = 5.28 [95% CI = 2.17-12.83] for NHL).
CONCLUSIONS
Low CD4/CD8 ratios and high CD8 counts despite effective cART were associated with increased KS/NHL risks respectively, especially when CD4 ≥ 500/mm3.
Identifiants
pubmed: 34370842
pii: 5880596
doi: 10.1093/cid/ciaa1137
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
50-59Subventions
Organisme : Medical Research Council
ID : MC_UU_00004/03
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/M004236/1
Pays : United Kingdom
Organisme : Agence Nationale de Recherches sur le Sida et les Hépatites Virales
Investigateurs
Ali Judd
(A)
Robert Zangerle
(R)
Giota Touloumi
(G)
Josiane Warszawski
(J)
Laurence Meyer
(L)
François Dabis
(F)
Murielle Mary Krause
(MM)
Jade Ghosn
(J)
Catherine Leport
(C)
Linda Wittkop
(L)
Peter Reiss
(P)
Ferdinand Wit
(F)
Maria Prins
(M)
Heiner Bucher
(H)
Diana Gibb
(D)
Gerd Fätkenheuer
(G)
Julia Del Amo
(J)
Niels Obel
(N)
Claire Thorne
(C)
Amanda Mocroft
(A)
Ole Kirk
(O)
Christoph Stephan
(C)
Santiago Pérez-Hoyos
(S)
Osamah Hamouda
(O)
Barbara Bartmeyer
(B)
Nikoloz Chkhartishvili
(N)
Antoni Noguera-Julian
(A)
Andrea Antinori
(A)
Antonella d'Arminio Monforte
(AD)
Norbert Brockmeyer
(N)
Luis Prieto
(L)
Pablo Rojo Conejo
(PR)
Antoni Soriano-Arandes
(A)
Manuel Battegay
(M)
Roger Kouyos
(R)
Cristina Mussini
(C)
Jordi Casabona
(J)
Jose M Miró
(JM)
Antonella Castagna
(A)
Deborah Konopnick
(D)
Tessa Goetghebuer
(T)
Anders Sönnerborg
(A)
Carlo Torti
(C)
Caroline Sabin
(C)
Ramon Teira
(R)
Myriam Garrido
(M)
David Haerry
(D)
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.