CD4/CD8 Ratio Recovery among People Living with HIV Starting with First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis

Win Min Han, Anchalee Avihingsanon, Reena Rajasuriar, Junko Tanuma, Sanjay Mundhe, Man Po Lee, Jun Yong Choi, Sanjay Pujari, Yu Jiun Chan, Agus Somia, Fujie Zhang, Nagalingeswaran Kumarasamy, Oon Tek Ng, Yasmin Gani, Romanee Chaiwarith, Thach Ngoc Pham, Cuong Duy Do, Rossana Ditangco, Sasisopin Kiertiburanakul, Vohith KholJeremy Ross, Awachana Jiamsakul, P. S. Ly, H. X. Zhao, N. Han, P. C.K. Li, W. Lam, Y. T. Chan, C. Ezhilarasi, K. Joshi, S. Gaikwad, A. Chitalikar, S. Sangle, V. Mave, I. Marbaniang, S. Nimkar, T. P. Merati, D. N. Wirawan, F. Yuliana, E. Yunihastuti, A. Widhani, S. Maria, T. H. Karjadi, S. Oka, T. Nishijima, S. Na, J. M. Kim, N. B. Rudi, I. Azwa, A. Kamarulzaman, S. F. Syed Omar, S. Ponnampalavanar, M. K. Pasayan, M. L. Mationg, W. W. Ku, P. C. Wu, E. Ke, P. L. Lim, L. S. Lee, D. Liang, S. Gatechompol, P. Phanuphak, C. Phadungphon, A. Phuphuakrat, L. Chumla, N. Sanmeema, T. Sirisanthana, J. Praparattanapan, K. Nuket, S. Khusuwan, P. Kantipong, P. Kambua, K. V. Nguyen, H. V. Bui, D. T.H. Nguyen, D. T. Nguyen, A. V. Ngo, L. T. Nguyen, A. H. Sohn, J. L. Ross, B. Petersen, M. G. Law, A. Jiamsakul, R. Bijker, D. Rupasinghe

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background:We evaluated trends in CD4/CD8 ratio among people living with HIV (PLWH) starting antiretroviral therapy (ART) with first-line integrase strand transfer inhibitors (INSTI) compared with non-INSTI-based ART, and the incidence of CD4/CD8 ratio normalization.Methods:All PLWH enrolled in adult HIV cohorts of IeDEA Asia-Pacific who started with triple-ART with at least 1 CD4, CD8 (3-month window), and HIV-1 RNA measurement post-ART were included. CD4/CD8 ratio normalization was defined as a ratio ≥1. Longitudinal changes in CD4/CD8 ratio were analyzed by linear mixed model, the incidence of the normalization by Cox regression, and the differences in ratio recovery by group-based trajectory modeling.Results:A total of 5529 PLWH were included; 80% male, median age 35 years (interquartile range [IQR], 29-43). First-line regimens were comprised of 65% NNRTI, 19% PI, and 16% INSTI. The baseline CD4/CD8 ratio was 0.19 (IQR, 0.09-0.33). PLWH starting with NNRTI-(P = 0.005) or PI-based ART (P = 0.030) had lower CD4/CD8 recovery over 5 years compared with INSTI. During 24,304 person-years of follow-up, 32% had CD4/CD8 ratio normalization. After adjusting for age, sex, baseline CD4, HIV-1 RNA, HCV, and year of ART initiation, PLWH started with INSTI had higher odds of achieving CD4/CD8 ratio normalization than NNRTI-(P < 0.001) or PI-based ART (P = 0.015). In group-based trajectory modeling analysis, INSTI was associated with greater odds of being in the higher ratio trajectory.Conclusions:INSTI use was associated with higher rates of CD4/CD8 ratio recovery and normalization in our cohort. These results emphasize the relative benefits of INSTI-based ART for immune restoration.

Original languageEnglish
Pages (from-to)180-188
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
Publication statusPublished - 1 Feb 2023


  • antiretroviral treatment
  • Asia-Pacific
  • CD4/CD8 ratio
  • immune dysfunction


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