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 Khol; Jeremy 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

doi:10.1097/QAI.0000000000003121

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

Department of Internal Medicine

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1 Citation (Scopus)

Abstract

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 language	English
Pages (from-to)	180-188
Number of pages	9
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	92
Issue number	2
DOIs	https://doi.org/10.1097/QAI.0000000000003121
Publication status	Published - 1 Feb 2023

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/QAI.0000000000003121

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Han, W. M., Avihingsanon, A., Rajasuriar, R., Tanuma, J., Mundhe, S., Lee, M. P., Choi, J. Y., Pujari, S., Chan, Y. J., Somia, A., Zhang, F., Kumarasamy, N., Tek Ng, O., Gani, Y., Chaiwarith, R., Pham, T. N., Do, C. D., Ditangco, R., Kiertiburanakul, S., ... Rupasinghe, D. (2023). CD4/CD8 Ratio Recovery among People Living with HIV Starting with First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis. Journal of Acquired Immune Deficiency Syndromes, 92(2), 180-188. https://doi.org/10.1097/QAI.0000000000003121

@article{a85d8d26eb774658ab9403ca2825d4bd,

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

abstract = "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.",

keywords = "antiretroviral treatment, Asia-Pacific, CD4/CD8 ratio, immune dysfunction, INSTI",

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

note = "Funding Information: Supported by the US National Institutes of Health's National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above. Publisher Copyright: {\textcopyright} 2023 Lippincott Williams and Wilkins. All rights reserved.",

year = "2023",

month = feb,

day = "1",

doi = "10.1097/QAI.0000000000003121",

language = "English",

volume = "92",

pages = "180--188",

journal = "Journal of Acquired Immune Deficiency Syndromes",

issn = "1525-4135",

publisher = "Wolters Kluwer Health",

number = "2",

}

Han, WM, Avihingsanon, A, Rajasuriar, R, Tanuma, J, Mundhe, S, Lee, MP, Choi, JY, Pujari, S, Chan, YJ, Somia, A, Zhang, F, Kumarasamy, N, Tek Ng, O, Gani, Y, Chaiwarith, R, Pham, TN, Do, CD, Ditangco, R, Kiertiburanakul, S, Khol, V, Ross, J, Jiamsakul, A, Ly, PS, Zhao, HX, Han, N, Li, PCK, Lam, W, Chan, YT, Ezhilarasi, C, Joshi, K, Gaikwad, S, Chitalikar, A, Sangle, S, Mave, V, Marbaniang, I, Nimkar, S, Merati, TP, Wirawan, DN, Yuliana, F, Yunihastuti, E , Widhani, A, Maria, S, Karjadi, TH, Oka, S, Nishijima, T, Na, S, Kim, JM, Rudi, NB, Azwa, I, Kamarulzaman, A, Syed Omar, SF, Ponnampalavanar, S, Pasayan, MK, Mationg, ML, Ku, WW, Wu, PC, Ke, E, Lim, PL, Lee, LS, Liang, D, Gatechompol, S, Phanuphak, P, Phadungphon, C, Phuphuakrat, A, Chumla, L, Sanmeema, N, Sirisanthana, T, Praparattanapan, J, Nuket, K, Khusuwan, S, Kantipong, P, Kambua, P, Nguyen, KV, Bui, HV, Nguyen, DTH, Nguyen, DT, Ngo, AV, Nguyen, LT, Sohn, AH, Ross, JL, Petersen, B, Law, MG, Jiamsakul, A, Bijker, R & Rupasinghe, D 2023, 'CD4/CD8 Ratio Recovery among People Living with HIV Starting with First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis', Journal of Acquired Immune Deficiency Syndromes, vol. 92, no. 2, pp. 180-188. https://doi.org/10.1097/QAI.0000000000003121

CD4/CD8 Ratio Recovery among People Living with HIV Starting with First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis. / Han, Win Min; Avihingsanon, Anchalee; Rajasuriar, Reena et al.
In: Journal of Acquired Immune Deficiency Syndromes, Vol. 92, No. 2, 01.02.2023, p. 180-188.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - CD4/CD8 Ratio Recovery among People Living with HIV Starting with First-Line Integrase Strand Transfer Inhibitors

T2 - A Prospective Regional Cohort Analysis

AU - Han, Win Min

AU - Avihingsanon, Anchalee

AU - Rajasuriar, Reena

AU - Tanuma, Junko

AU - Mundhe, Sanjay

AU - Lee, Man Po

AU - Choi, Jun Yong

AU - Pujari, Sanjay

AU - Chan, Yu Jiun

AU - Somia, Agus

AU - Zhang, Fujie

AU - Kumarasamy, Nagalingeswaran

AU - Tek Ng, Oon

AU - Gani, Yasmin

AU - Chaiwarith, Romanee

AU - Pham, Thach Ngoc

AU - Do, Cuong Duy

AU - Ditangco, Rossana

AU - Kiertiburanakul, Sasisopin

AU - Khol, Vohith

AU - Ross, Jeremy

AU - Jiamsakul, Awachana

AU - Ly, P. S.

AU - Zhao, H. X.

AU - Han, N.

AU - Li, P. C.K.

AU - Lam, W.

AU - Chan, Y. T.

AU - Ezhilarasi, C.

AU - Joshi, K.

AU - Gaikwad, S.

AU - Chitalikar, A.

AU - Sangle, S.

AU - Mave, V.

AU - Marbaniang, I.

AU - Nimkar, S.

AU - Merati, T. P.

AU - Wirawan, D. N.

AU - Yuliana, F.

AU - Yunihastuti, E.

AU - Widhani, A.

AU - Maria, S.

AU - Karjadi, T. H.

AU - Oka, S.

AU - Nishijima, T.

AU - Na, S.

AU - Kim, J. M.

AU - Rudi, N. B.

AU - Azwa, I.

AU - Kamarulzaman, A.

AU - Syed Omar, S. F.

AU - Ponnampalavanar, S.

AU - Pasayan, M. K.

AU - Mationg, M. L.

AU - Ku, W. W.

AU - Wu, P. C.

AU - Ke, E.

AU - Lim, P. L.

AU - Lee, L. S.

AU - Liang, D.

AU - Gatechompol, S.

AU - Phanuphak, P.

AU - Phadungphon, C.

AU - Phuphuakrat, A.

AU - Chumla, L.

AU - Sanmeema, N.

AU - Sirisanthana, T.

AU - Praparattanapan, J.

AU - Nuket, K.

AU - Khusuwan, S.

AU - Kantipong, P.

AU - Kambua, P.

AU - Nguyen, K. V.

AU - Bui, H. V.

AU - Nguyen, D. T.H.

AU - Nguyen, D. T.

AU - Ngo, A. V.

AU - Nguyen, L. T.

AU - Sohn, A. H.

AU - Ross, J. L.

AU - Petersen, B.

AU - Law, M. G.

AU - Jiamsakul, A.

AU - Bijker, R.

AU - Rupasinghe, D.

N1 - Funding Information: Supported by the US National Institutes of Health's National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.

PY - 2023/2/1

Y1 - 2023/2/1

N2 - 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.

AB - 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.

KW - antiretroviral treatment

KW - Asia-Pacific

KW - CD4/CD8 ratio

KW - immune dysfunction

KW - INSTI

UR - http://www.scopus.com/inward/record.url?scp=85146139741&partnerID=8YFLogxK

U2 - 10.1097/QAI.0000000000003121

DO - 10.1097/QAI.0000000000003121

M3 - Article

C2 - 36625858

AN - SCOPUS:85146139741

SN - 1525-4135

VL - 92

SP - 180

EP - 188

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

IS - 2

ER -

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

Abstract

Keywords

UN SDGs

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