Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
National Institute for Infectious Diseases L. Spallanzani, Rome, Italy.
BMC Med. 2018 May 29;16(1):79. doi: 10.1186/s12916-018-1046-2.
The CD4/CD8 ratio has been associated with the risk of AIDS and non-AIDS events. We describe trends in immunological parameters in people who underwent a switch to monotherapy or dual therapy, compared to a control group remaining on triple antiretroviral therapy (ART).
We included patients in Icona who started a three-drug combination ART regimen from an ART-naïve status and achieved a viral load ≤ 50 copies/mL; they were subsequently switched to another triple or to a mono or double regimen. Standard linear regression at fixed points in time (12-24 months after the switch) and linear mixed model analysis with random intercepts and slopes were used to compare CD4 and CD8 counts and their ratio over time according to regimen types (triple vs. dual and vs. mono).
A total of 1241 patients were included; 1073 switched to triple regimens, 104 to dual (72 with 1 nucleoside reverse transcriptase inhibitor (NRTI), 32 NRTI-sparing), and 64 to monotherapy. At 12 months after the switch, for the multivariable linear regression the mean change in the log CD4/CD8 ratio for patients on dual therapy was -0.03 (95% confidence interval (CI) -0.05, -0.0002), and the mean change in CD8 count was +99 (95% CI +12.1, +186.3), taking those on triple therapy as reference. In contrast, there was no evidence for a difference in CD4 count change. When using all counts, there was evidence for a significant difference in the slope of the ratio and CD8 count between people who were switched to triple (points/year change ratio = +0.056, CD8 = -25.7) and those to dual regimen (ratio = -0.029, CD8 = +110.4).
We found an increase in CD8 lymphocytes in people who were switched to dual regimens compared to those who were switched to triple. Patients on monotherapy did not show significant differences. The long-term implications of this difference should be ascertained.
CD4/CD8 比值与艾滋病和非艾滋病事件的风险相关。我们描述了接受单药或双药治疗转换的患者与继续接受三药抗逆转录病毒治疗（ART）的对照组相比，免疫参数的变化趋势。
我们纳入了 Icona 中从 ART 初治开始接受三联药物组合 ART 方案且病毒载量≤50 拷贝/mL 的患者，随后他们转换为另一种三联或单药或二联方案。采用固定时间点（转换后 12-24 个月）的标准线性回归和具有随机截距和斜率的线性混合模型分析，根据方案类型（三联与双联和与单药）比较 CD4 和 CD8 计数及其比值随时间的变化。
共纳入 1241 例患者；1073 例患者转换为三联方案，104 例转换为双联（72 例含 1 种核苷逆转录酶抑制剂（NRTI），32 例 NRTI 节省），64 例转换为单药治疗。在转换后 12 个月时，对于多变量线性回归，接受双联治疗的患者的 CD4/CD8 比值的平均变化为-0.03（95%置信区间（CI）-0.05，-0.0002），CD8 计数的平均变化为+99（95%CI +12.1，+186.3），以接受三联治疗的患者为参考。相比之下，CD4 计数变化没有证据表明存在差异。当使用所有计数时，转换为三联方案（比值斜率变化点/年=+0.056，CD8=-25.7）和转换为双联方案（比值=-0.029，CD8=+110.4）的患者之间的比值和 CD8 计数的斜率存在显著差异。
我们发现与转换为三联方案的患者相比，转换为双联方案的患者的 CD8 淋巴细胞增加。接受单药治疗的患者没有表现出显著差异。应该确定这种差异的长期影响。
