Delay in cART Initiation Results in Persistent Immune Dysregulation and Poor Recovery of T-Cell Phenotype Despite a Decade of Successful HIV Suppression

Abstract

The immune system of healthy individuals is characterized by the maintenance of homeostasis via a balanced T-cell phenotype (TCP). Although the hallmark of HIV infection is progressive CD4+ T-cell depletion, other impairments in immune phenotype such as loss of T-cell homeostasis and severe T-cell subset dysregulation also occur.T-cell subset dysregulation was the earliest noted surrogate marker of AIDS in the early 1980s. It is characterized by a low CD4:CD8 T-cell ratio (<1.2) resulting from the depletion of CD4+ T-cells and the concomitant expansion of the CD8+ population of T-cells in the peripheral blood. Studies have shown that in HIV seropositive individuals receiving long-term combination antiretroviral therapy (cART), CD4:CD8 T-cell ratio dysregulation is correlated with higher risk of developing coronary artery disease