Qin Fengxiang, Lv Qing, Hong Wen, Wei Di, Huang Kui, Lan Ke, Chen Rongfeng, Liu Jie, Liang Bingyu, Liang Huayue, Liang Hao, Qin Shanfang, Ye Li, Jiang Junjun
Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.
Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China.
Front Microbiol. 2022 Feb 10;13:827689. doi: 10.3389/fmicb.2022.827689. eCollection 2022.
CD4/CD8 ratio is considered as an emerging biomarker for human immunodeficiency virus (HIV)-related diseases. However, the relationship of CD4/CD8 ratio recovery and chronic kidney disease (CKD), and whether cumulative antiretroviral therapy (ART) is effective in the CD4/CD8 ratio recovery and in reducing CKD incidence among HIV patients remain unclear.
A 17-year observational cohort study was conducted on all HIV-infected patients receiving ART in Guangxi, China. Kaplan-Meier analysis was used to investigate the cumulative CKD incidence. Cox regression and propensity score matching (PSM) were used to evaluate the association between CD4/CD8 ratio recovery and CKD incidence, and the effect of ART regimens on CD4/CD8 ratio recovery and CKD incidence.
A total of 59,268 eligible individuals contributing 285,143 person-years of follow-up, with an overall CKD incidence of 9.65%. After ART, patients who developed CKD showed higher mortality than those with normal kidney function (12.48 vs. 7.57%, < 0.001). Patients whose CD4/CD8 ratio did not recover to 0.7 had a higher CKD incidence than the patients who recovered (aHR = 2.84, 95% CI 2.63-3.07), similar to the PSM analysis (aHR = 3.13, 95% CI 2.85-3.45). Compared with the PI-based and INSTI-based regimens, NNRTI-based regimen had a better CD4/CD8 ratio recovery rate (27.04, 16.16, and 29.66%, respectively) and a lower CKD incidence (17.43, 16.16, and 7.31%, respectively).
This large-scale real-world setting provide new evidence that the CD4/CD8 ratio recovery is associated with lower CKD incidence in HIV-infected patients receiving ART. NNRTI-based is a better choice for CD4/CD8 ratio recovery and reducing the risk of CKD.
CD4/CD8 比值被认为是一种新兴的与人类免疫缺陷病毒（HIV）相关疾病的生物标志物。然而，CD4/CD8 比值恢复与慢性肾脏病（CKD）之间的关系，以及累积抗逆转录病毒疗法（ART）在 HIV 患者中对 CD4/CD8 比值恢复和降低 CKD 发病率是否有效仍不清楚。
对中国广西所有接受 ART 的 HIV 感染患者进行了一项为期 17 年的观察性队列研究。采用 Kaplan-Meier 分析来研究累积 CKD 发病率。使用 Cox 回归和倾向得分匹配（PSM）来评估 CD4/CD8 比值恢复与 CKD 发病率之间的关联，以及 ART 方案对 CD4/CD8 比值恢复和 CKD 发病率的影响。
共有 59268 名符合条件的个体，随访时间总计 285143 人年，总体 CKD 发病率为 9.65%。ART 治疗后，发生 CKD 的患者死亡率高于肾功能正常的患者（12.48%对 7.57%，<0.001）。CD4/CD8 比值未恢复到 0.7 的患者 CKD 发病率高于恢复的患者（调整后风险比[aHR]=2.84，95%置信区间[CI]2.63 - 3.07），PSM 分析结果类似（aHR = 3.13，95%CI 2.85 - 3.45）。与基于蛋白酶抑制剂（PI）和基于整合酶链转移抑制剂（INSTI）的方案相比，基于非核苷类逆转录酶抑制剂（NNRTI）的方案具有更好的 CD4/CD8 比值恢复率（分别为 27.04%、16.16%和 29.66%）和更低的 CKD 发病率（分别为 17.43%、16.16%和 7.31%）。
这一大规模的真实世界研究提供了新的证据，表明在接受 ART 的 HIV 感染患者中，CD4/CD8 比值恢复与较低的 CKD 发病率相关。基于 NNRTI 的方案是 CD4/CD8 比值恢复和降低 CKD 风险的更好选择。
