Retrospective analysis of the Canadian Observational Cohort (CANOC), an interprovincial cohort of ART-naive adults living with HIV, recruited from 11 treatment centres across Canada. We studied participants initiating ART between 1 January 2011 and 31 December 2016 with baseline CD4 : CD8 ratio <1.0 and ≥2 follow-up measurements. Normalization was defined as two consecutive CD4 : CD8 ratios ≥1.0. Kaplan-Meier estimates and log-rank tests described time to normalization. Univariable and multivariable proportional hazards (PH) models identified factors associated with ratio normalization.
Among 3218 participants, 909 (28%) normalized during a median 2.6 years of follow-up. Participants with higher baseline CD4+ T-cell count were more likely to achieve normalization; the probability of normalization by 5 years was 0.68 (95% CI 0.62-0.74) for those with baseline CD4+ T-cell count >500 cells/mm3 compared with 0.16 (95% CI 0.11-0.21) for those with ≤200 cells/mm3 (P < 0.0001). In a multivariable PH model, baseline CD4+ T-cell count was associated with a higher likelihood of achieving ratio normalization (adjusted HR = 1.5, 95% CI 1.5-1.6 per 100 cells/mm3, P < 0.0001). After adjusting for baseline characteristics, time-dependent ART class was not associated with ratio normalization.
Early ART initiation, at higher baseline CD4+ T-cell counts, has the greatest impact on CD4 : CD8 ratio normalization. Our study supports current treatment guidelines recommending immediate ART start, with no difference in ratio normalization observed based on ART class used.
加拿大观察队列(CANOC)的回顾性分析,一个跨省队列的抗逆转录病毒成人感染艾滋病毒,从加拿大的11个治疗中心招募。我们研究了在2011年1月1日至2016年12月31日之间开始ART的参与者,基线CD4:CD8比率<1.0和≥2次随访测量。标准化定义为两个连续的CD4:CD8比率≥1.0。Kaplan-Meier估计和对数秩检验描述了归一化时间。单变量和多变量比例风险(PH)模型确定了与比率归一化相关的因素。
在3218名参与者中,909(28%)在中位2.6年的随访期间恢复正常。基线CD4+T细胞计数较高的参与者更有可能实现正常化;基线CD4+T细胞计数>500细胞/mm3的参与者5年正常化的概率为0.68(95%CI0.62-0.74),而≤200细胞/mm3的参与者为0.16(95%CI0.11-0.21)(P<0.0001)。在多变量PH模型中,基线CD4+T细胞计数与实现比值正常化的可能性较高相关(校正后HR=1.5,95%CI1.5-1.6/100细胞/mm3,P<0.0001).调整基线特性后,时间依赖性ART类别与比率正常化无关.
早期ART启动,在较高的基线CD4+T细胞计数,对CD4:CD8比值正常化的影响最大。我们的研究支持目前的治疗指南,建议立即开始ART,根据使用的ART类别观察到的比率归一化没有差异。