Association Between CD4/CD8 Ratio Recovery and Chronic Kidney Disease Among Human Immunodeficiency Virus-Infected Patients Receiving Antiretroviral Therapy: A 17-Year Observational Cohort Study

Fengxiang Qin; Qing Lv; Wen Hong; Di Wei; Kui Huang; Ke Lan; Rongfeng Chen; Jie Liu; Bingyu Liang; Huayue Liang; Hao Liang; Shanfang Qin; Li Ye; Junjun Jiang

doi:10.3389/fmicb.2022.827689

Association Between CD4/CD8 Ratio Recovery and Chronic Kidney Disease Among Human Immunodeficiency Virus-Infected Patients Receiving Antiretroviral Therapy: A 17-Year Observational Cohort Study

Front Microbiol. 2022 Feb 10:13:827689. doi: 10.3389/fmicb.2022.827689. eCollection 2022.

Authors

Fengxiang Qin^{1

2}, Qing Lv³, Wen Hong¹, Di Wei³, Kui Huang³, Ke Lan³, Rongfeng Chen^{1

2}, Jie Liu^{1

2}, Bingyu Liang¹, Huayue Liang¹, Hao Liang^{1

2}, Shanfang Qin³, Li Ye^{1

2}, Junjun Jiang^{1

2}

Affiliations

¹ Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.
² Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China.
³ Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China.

Abstract

Background: CD4/CD8 ratio is considered as an emerging biomarker for human immunodeficiency virus (HIV)-related diseases. However, the relationship of CD4/CD8 ratio recovery and chronic kidney disease (CKD), and whether cumulative antiretroviral therapy (ART) is effective in the CD4/CD8 ratio recovery and in reducing CKD incidence among HIV patients remain unclear.

Methods: A 17-year observational cohort study was conducted on all HIV-infected patients receiving ART in Guangxi, China. Kaplan-Meier analysis was used to investigate the cumulative CKD incidence. Cox regression and propensity score matching (PSM) were used to evaluate the association between CD4/CD8 ratio recovery and CKD incidence, and the effect of ART regimens on CD4/CD8 ratio recovery and CKD incidence.

Results: A total of 59,268 eligible individuals contributing 285,143 person-years of follow-up, with an overall CKD incidence of 9.65%. After ART, patients who developed CKD showed higher mortality than those with normal kidney function (12.48 vs. 7.57%, p < 0.001). Patients whose CD4/CD8 ratio did not recover to 0.7 had a higher CKD incidence than the patients who recovered (aHR = 2.84, 95% CI 2.63-3.07), similar to the PSM analysis (aHR = 3.13, 95% CI 2.85-3.45). Compared with the PI-based and INSTI-based regimens, NNRTI-based regimen had a better CD4/CD8 ratio recovery rate (27.04, 16.16, and 29.66%, respectively) and a lower CKD incidence (17.43, 16.16, and 7.31%, respectively).

Conclusion: This large-scale real-world setting provide new evidence that the CD4/CD8 ratio recovery is associated with lower CKD incidence in HIV-infected patients receiving ART. NNRTI-based is a better choice for CD4/CD8 ratio recovery and reducing the risk of CKD.

Keywords: AIDS; CD4/CD8; HIV; antiretroviral therapy; chronic kidney disease.