CD4/CD8 Ratio Recovery of Children and Adolescents Living With HIV With Virological Suppression - A Prospective Cohort Study

Q: What does the study define as CD4/CD8 ratio normalization after virological suppression?

Normalization was defined as two consecutive CD4/CD8 ratio values ≥1 following achievement of HIV RNA <50 copies/mL and an initial ratio <0.8 at suppression.

Q: Who was eligible to participate in this prospective cohort study?

Children and adolescents who started combination antiretroviral therapy at age ≥5 years were eligible if they achieved HIV RNA <50 copies/mL and had a CD4/CD8 ratio <0.8 at the time of virological suppression.

Q: What main conclusion did the study reach about CD4/CD8 ratio normalization?

Less than half of children and adolescents with HIV on suppressive combination antiretroviral therapy achieved CD4/CD8 ratio normalization, and slower recovery was associated with older age at cART initiation and lower pre-cART CD4 measures.

Sep 24, 2026

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CD4/CD8 ratio recovery after viral suppression remains insufficiently characterized in young people with HIV. This prospective cohort study enrolled Thai children and adolescents initiating combination antiretroviral therapy at age ≥5 years, who achieved HIV RNA <50 copies/mL and had a baseline CD4/CD8 ratio <0.8 at suppression. CD4/CD8 normalization required two consecutive ratios ≥1, assessed using group-based trajectory analysis. Fewer than half normalized over time; normalization incidence was low, and slower recovery was linked to older initiation age and lower pre-cART CD4 metrics.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Background

Methods

Results

Conclusions

Key words

Journal of the Pediatric Infectious Diseases Society ORIGINAL ARTICLE CD4/CD8 Ratio Recovery of Children and Adolescents Living With HIV With Virological Suppression: A Prospective Cohort Study Win Min Han,1 Tanakorn Apornpong,1 Ryan Handoko,2 Watsamon Jantarabenjakul,3,4 Sivaporn Gatechompol,1 Sasiwimol Ubolyam,1 Stephen J. Kerr,1,5 Anchalee Avihingsanon,1,6 Kiat Ruxrungtham,1,6 Praphan Phanuphak,1,7 and Thanyawee Puthanakit,3,4; on behalf of the HIV-NAT 015 and 006 Teams 1The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; 2Yale University, New Haven, Connecticut, USA; 3Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 4Center of Excellence in Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 5Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 6Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; and 7PREVENTION, Thai Red Cross AIDS Research Centre, Bangkok, Thailand Background. There are limited data on immune restoration of young adults living with virologically suppressed human immunodeficiency virus (HIV). We investigated recovery rates of CD4/CD8 ratio among Thai children and adolescents after they initiated combination antiretroviral therapy (cART) . Methods. Children and adolescents who started cART at age of ≥ 5 years were eligible in this study if they achieved HIV RNA < 50 copies/mL and had a CD4/CD8 ratio < 0.8 at the time of virological suppression. Normalization of CD4/CD8 ratio was defined as 2 consecutive values ≥ 1. Using group-based trajectory analysis, low-and high-recovery groups were identified in terms of CD4/CD8 ratio recovery. Results. One hundred thirty-eight children and adolescents (101 perinatally infected and 37 behaviorally infected) with median age of 10.6 years at cART treatment initiation were included. After 559 person-years of follow-up (PYFU), overall incidence rate of CD4/CD8 ratio normalization was 4.1 (95% confidence interval, 2.7–6.2) per 100 PYFU. The probabilities of normalization at 2, 5, and 10 years after HIV suppression were 5.2%, 22.6%, and 35.6%, respectively. The low-recovery group had lower median pre-cART CD4 count (146 vs 304 cells/μL, P = .01), pre-cART CD4/CD8 ratio (0.15 vs 0.23, P = .03) and at first viral suppression (0.38 vs 0.65, P = .0001), compared to the high-recovery group. Conclusions. Less than half of children and adolescents living with HIV on cART with viral suppression had CD4/CD8 ratio normalization. Those with older age at cART initiation, lower pre-cART CD4 count, or CD4/CD8 ratio had slower ratio recovery. Long-term prognoses such as ongoing immune activation and clinical outcomes among children and adolescents on suppressive cART without CD4/CD8 ratio normalization need to be further investigated. Key words. CD4/CD8 ratio; children and adolescents living with HIV; immune restoration; virological suppression. Globally, there are more than 1.8 million children < 15 years old currently living with human immunodeficiency virus (HIV), with a majority of perinatal acquisition [ 1] . Due to advances in combined antiretroviral therapy (cART) and better healthcare systems, longevity and quality of life of people living with HIV (PLWH) have been largely improved [2, 3] . Since cART has been recommended in all PLWH regardless of age and CD4+ cell count, marked reduction in AIDS-defining events and mortality have also been observed [4, 5] . However, concerns on the longitudinal effects of chronic HIV infection in both children Received 23 August 2019; editorial decision 20 February 2020; accepted 24 February 2020; Published online March 19, 2020. Correspondence: Win Min Han, MBBS, MSc, HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd, Pathumwan, Bangkok, Thailand 10330 ([win.m@hi

FAQs

What does the study define as CD4/CD8 ratio normalization after virological suppression?

Normalization was defined as two consecutive CD4/CD8 ratio values ≥1 following achievement of HIV RNA <50 copies/mL and an initial ratio <0.8 at suppression.

Who was eligible to participate in this prospective cohort study?

Children and adolescents who started combination antiretroviral therapy at age ≥5 years were eligible if they achieved HIV RNA <50 copies/mL and had a CD4/CD8 ratio <0.8 at the time of virological suppression.

What main conclusion did the study reach about CD4/CD8 ratio normalization?

Less than half of children and adolescents with HIV on suppressive combination antiretroviral therapy achieved CD4/CD8 ratio normalization, and slower recovery was associated with older age at cART initiation and lower pre-cART CD4 measures.

Sep 24, 2026

Uploaded by Theodore