The impact of age on the prognostic capacity of CD8+ T-cell activation during suppressive antiretroviral therapy

Judith J. Lok, Peter W. Hunt, Ann C. Collier, Constance A. Benson, Mallory D. Witt, Amneris E. Luque, Steven G. Deeks, Ronald J. Bosch

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Objective: To assess whether CD8+ T-cell activation predicts risk of AIDS and non- AIDS morbidity during suppressive antiretroviral treatment (ART). Design: Posthoc analyses of ART-naive participants in prospective ART studies. Participants with HIV-RNA levels 200 copies/ml or less and CD8 + T-cell activation data (%CD38+HLA-DR+) at year-1 of ART were selected to determine years 2-5 incidence of AIDS and non-AIDS events. Methods: We censored data at time of ART interruption or virologic failure. Inverse probability of censoring-weighted logistic regression was used to correct for informative censoring. Results: We included 1025 participants; 82% were men, median age 38 years, pre-ART CD4 cell count 255 cells/μl, and year-1-activated CD8+ T cells 24%. Of these, 752 had 5 years of follow-up; 379 remained on ART and had no confirmed plasma HIV-RNA more than 200 copies/ml. The overall probability of an AIDS or non-AIDS event in years 2-5 was estimated at 13% [95% confidence interval (CI) 10-15%] had everyone remained on suppressive ART. Higher year-1-activated CD8+ T-cell percentage increased the probability of subsequent events [odds ratio 1.22 per 10% higher (95% CI 1.04-1.44)]; this effect was not significant after adjusting for age. Among those age 50 years at least (n=108 at year 1), the probability of an event in years 2-5 was 37% and the effect of CD8+ T-cell activation was more apparent (odds ratio=1.42, P=0.02 unadjusted and adjusted for age). Conclusion: CD8+ T-cell activation is prognostic of clinical events during suppressive ART, although this association is confounded by age. The consequences of HIVassociated immune activation may be more important in patients 50 years and older.

Original languageEnglish (US)
Pages (from-to)2101-2110
Number of pages10
JournalAIDS
Volume27
Issue number13
DOIs
StatePublished - Aug 24 2013

Keywords

  • Antiretroviral therapy
  • CD8+ T-cell activation
  • HIV/AIDS
  • Loss to follow-up
  • Observational data
  • Virologic suppression

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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