Journal Article Ahead of print
PubMed: 41748859 DOI: 10.1007/s15010-026-02740-y
Long-term immune recovery under continuous antiretroviral therapy (ART) among ART-naive people living with HIV in two cohorts in Germany.
Infection
Authors: Uwe Koppe, Kirsten Pörtner, Christian Kollan, Annemarie Pantke, Andrea Sailer, Kerstin Dehmel, Stefan Esser, Björn-Erik Ole Jensen, Jürgen Kurt Rockstroh, Guido Schäfer, Dirk Schürmann, Matthias Stoll, Jan-Christian Wasmuth, Tobias Kurth, Barbara Gunsenheimer-Bartmeyer
Affiliations
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- Department of Medicine I, University Hospital Bonn, Bonn, Germany.
- Infektionsmedizinisches Centrum Hamburg, MVZ ICH Grindel, Hamburg, Germany.
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany.
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Abstract
OBJECTIVES
Immune recovery among people living with HIV (PWHIV) receiving antiretroviral therapy (ART) is determined analysing CD4 cell counts and the CD4/CD8 ratio. Recovery to ≥ 800 CD4 cells/µl and CD4/CD8 ratio ≥ 1 was associated with favourable outcomes. We investigated immune recovery over 10 years among ART-naive PWHIV on ART.
METHODS
Data were obtained from two German HIV cohorts, the HIV-1 Seroconverter study and the ClinSurv-HIV study, between 2003 and 2018. We included ART-naïve PWHIV starting with continuous ART and analysed CD4 cell counts and the CD4/CD8 ratio. The time to reaching immune thresholds was investigated using Kaplan-Meier analyses with inverse probability censoring weights.
RESULTS
Overall, 8,927 participants were included. At baseline, PWHIV had a median CD4 cell count of 257 (interquartile range [IQR] 124-393) cells/µl and CD4/CD8 ratio of 0.26 (IQR 0.14-0.43). After ten years, median CD4 counts increased to 630 (IQR 474-811) cells/µl and CD4/CD8 ratio to 0.84 (IQR 0.61-1.11). PWHIV with higher baseline CD4 values and without viral failure had higher median CD4 counts and CD4/CD8 ratios. The cumulative probability of achieving a CD4 count ≥ 800 cells/µl and/or CD4/CD8 ratio ≥ 1 over 10 years of ART were 54% for the CD4 threshold, 53% for the CD4/CD8 ratio threshold, and 32% for both thresholds. CD4 at baseline was identified as a predictor to achieve immune recovery in all models.
CONCLUSIONS
Early diagnosis and treatment, as well as effective antiviral therapy without viral failure, should be considered to achieve long-term immune recovery among PWHIV.
MeSH
Cd4 Lymphocyte Count, Cells, Probability, Recycling, Cd4-Cd8 Ratio, Hiv, Cell Count, Therapeutics, Art Therapy, Infections