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.
Clin Infect Dis
; 73(1): 50-59, 2021 07 01.
Article
en En
| MEDLINE
| ID: mdl-34370842
ABSTRACT
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 loadâ ≤â 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 CD4â ≥â 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]â =â 2.02 [95% confidence interval {CIâ } =â 1.23-3.31]) when comparing CD4/CD8â =â 0.3 to CD4/CD8â =â 1) but not with NHL risk. High CD8 counts were associated with higher NHL risk (HRâ =â 3.14 [95% CIâ =â 1.58-6.22]) when comparing CD8â =â 3000/mm3 to CD8â =â 1000/mm3). Similar results with increased associations were found in PLWH with CD4â ≥â 500/mm3 at virological control (HRâ =â 3.27 [95% CIâ =â 1.60-6.56] for KS; HRâ =â 5.28 [95% CIâ =â 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 CD4â ≥â 500/mm3.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Sarcoma de Kaposi
/
Linfoma no Hodgkin
/
Infecciones por VIH
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Año:
2021
Tipo del documento:
Article