PDF(Pubmed)
Abstract：
In people living with HIV (PLHIV), the CD4/CD8 ratio has been proposed as a useful marker for non-AIDS events. However, its predictive ability on mortality over CD4 counts, and the role of CD8+ T-cell counts remain controversial.
We conducted a systematic review and meta-analysis of published studies from 1996 to 2023, including PLHIV on antiretroviral treatment, and reporting CD4/CD8 ratio or CD8+ counts. The primary outcome was non-AIDS mortality or all-cause mortality. We performed a standard random-effects pairwise meta-analysis comparing low versus high CD4/CD8 ratio with a predefined cut-off point of 0.5. (CRD42020170931).
We identified 2,479 studies for screening. 20 studies were included in the systematic review. Seven studies found an association between low CD4/CD8 ratio categories and increased mortality risk, with variable cut-off points between 0.4-1. Four studies were selected for meta-analysis, including 12,893 participants and 618 reported deaths. Patients with values of CD4/CD8 ratio below 0.5 showed a higher mortality risk (OR 3.65; 95% CI 3.04 - 4.35; I2 = 0.00%) compared to those with higher values. While the meta-analysis of CD8+ T-cell counts was not feasible due to methodological differences between studies, the systematic review suggests a negative prognostic impact of higher values (>1,138 to 1,500 cells/uL) in the long term.
Our results support the use of the CD4/CD8 ratio as a prognostic marker in clinical practice, especially in patients with values below 0.5, but consensus criteria on ratio timing measurement, cut-off values, and time to event are needed in future studies to get more robust conclusions.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020170931, identifier CRD42020170931.
We conducted a systematic review and meta-analysis of published studies from 1996 to 2023, including PLHIV on antiretroviral treatment, and reporting CD4/CD8 ratio or CD8+ counts. The primary outcome was non-AIDS mortality or all-cause mortality. We performed a standard random-effects pairwise meta-analysis comparing low versus high CD4/CD8 ratio with a predefined cut-off point of 0.5. (CRD42020170931).
We identified 2,479 studies for screening. 20 studies were included in the systematic review. Seven studies found an association between low CD4/CD8 ratio categories and increased mortality risk, with variable cut-off points between 0.4-1. Four studies were selected for meta-analysis, including 12,893 participants and 618 reported deaths. Patients with values of CD4/CD8 ratio below 0.5 showed a higher mortality risk (OR 3.65; 95% CI 3.04 - 4.35; I2 = 0.00%) compared to those with higher values. While the meta-analysis of CD8+ T-cell counts was not feasible due to methodological differences between studies, the systematic review suggests a negative prognostic impact of higher values (>1,138 to 1,500 cells/uL) in the long term.
Our results support the use of the CD4/CD8 ratio as a prognostic marker in clinical practice, especially in patients with values below 0.5, but consensus criteria on ratio timing measurement, cut-off values, and time to event are needed in future studies to get more robust conclusions.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020170931, identifier CRD42020170931.
摘要：
■在艾滋病毒携带者（PLHIV）中，CD4/CD8比值已被提议作为非AIDS事件的有用标志物.然而,它对CD4计数死亡率的预测能力，CD8+T细胞计数的作用仍存在争议。
■我们对1996年至2023年已发表的研究进行了系统评价和荟萃分析，包括抗逆转录病毒治疗的PLHIV，并报告CD4/CD8比值或CD8+计数。主要结果是非艾滋病死亡率或全因死亡率。我们进行了标准的随机效应成对荟萃分析，比较了低和高CD4/CD8比率以及预定义的0.5截止点。(CRD42020170931)。
■我们确定了2,479项筛查研究。20项研究纳入系统评价。七项研究发现，低CD4/CD8比率类别与死亡风险增加之间存在关联。具有0.4-1之间的可变截止点。选择了四项研究进行荟萃分析，包括12,893名参与者和618名报告死亡。与CD4/CD8比值低于0.5的患者相比，具有更高的死亡风险（OR3.65;95％CI3.04-4.35;I2=0.00％）。虽然由于研究之间的方法学差异，CD8+T细胞计数的荟萃分析不可行，系统评价提示长期较高值(>1,138~1,500细胞/uL)对预后有负面影响.
■我们的结果支持在临床实践中使用CD4/CD8比率作为预后指标，特别是在值低于0.5的患者中，但在比率计时测量上有共识的标准，截止值，在未来的研究中，需要时间来处理事件，以获得更有力的结论。
■https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42020170931，标识符CRD42020170931。
■我们对1996年至2023年已发表的研究进行了系统评价和荟萃分析，包括抗逆转录病毒治疗的PLHIV，并报告CD4/CD8比值或CD8+计数。主要结果是非艾滋病死亡率或全因死亡率。我们进行了标准的随机效应成对荟萃分析，比较了低和高CD4/CD8比率以及预定义的0.5截止点。(CRD42020170931)。
■我们确定了2,479项筛查研究。20项研究纳入系统评价。七项研究发现，低CD4/CD8比率类别与死亡风险增加之间存在关联。具有0.4-1之间的可变截止点。选择了四项研究进行荟萃分析，包括12,893名参与者和618名报告死亡。与CD4/CD8比值低于0.5的患者相比，具有更高的死亡风险（OR3.65;95％CI3.04-4.35;I2=0.00％）。虽然由于研究之间的方法学差异，CD8+T细胞计数的荟萃分析不可行，系统评价提示长期较高值(>1,138~1,500细胞/uL)对预后有负面影响.
■我们的结果支持在临床实践中使用CD4/CD8比率作为预后指标，特别是在值低于0.5的患者中，但在比率计时测量上有共识的标准，截止值，在未来的研究中，需要时间来处理事件，以获得更有力的结论。
■https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42020170931，标识符CRD42020170931。
