Trajectories of CD4 T‐cell count, CD8 T‐cell count, and CD4/CD8 ratio in patients with HIV and long‐term virological suppression based on Yunnan HIV cohort

Abstract Objective Our objective was to evaluate the trajectory of immunology in patients with HIV with different baseline CD4 T‐cell count strata after antiretroviral therapy (ART) under long‐term viral suppression. Methods This was a sub‐analysis focused on patients with virological suppression for at least 5 years after ART. Data were obtained from the Yunnan HIV cohort in China. Patients were categorized according to prespecified baseline CD4 T‐cell counts. The trajectories of CD4 T‐cell count, CD8 T‐cell count, and CD4/CD8 ratio changing over time were fitted using a B‐spline regression model. The Cox proportional hazards regression model was used to assess the association of baseline CD4 T‐cell count with the risk of both immunological responder (IR) and CD4/CD8 ratio normalization. Results A total of 2618 patients with a median follow‐up of 7.25 years (interquartile range [IQR] 5.92–8.75) were included. Over a period of 12 years, the mean CD4 T‐cell count remained above 500 cells/μL in all groups. The mean CD4/CD8 ratio was solely normalized in patients whose baseline CD4 T‐cell counts were above 350 cells/μL. Patients with higher baseline CD4 T‐cell counts showed higher risks of both IR and CD4/CD8 ratio normalization than those with the lowest (all p trend <0.001). A higher baseline CD4 T‐cell count predicted a shorter time for both IR and CD4/CD8 ratio normalization. Conclusions Long‐term, sustained viral suppression may not be able to fully normalize immunological functions in patients with HIV. A high baseline CD4 T‐cell count benefits IR and CD4/CD8 ratio normalization.