CD4/CD8 ratio in pregnant women with HIV and its association with pregnancy outcome: data from a national study in Italy

Abstract

To evaluate associations between CD4/CD8 ratio and pregnancy outcomes in women with HIV. We evaluated, in a national study of pregnant women with HIV receiving antiretroviral treatment (ART), values of CD4/CD8 ratio at entry in pregnancy, changes between first and third trimester, and possible associations with preterm delivery, low birthweight, and HIV-RNA\u2009<\u200950 copies/ml at third trimester in univariate and multivariate analyses. Among 934 women, 536 (57.4%) were already on ART at conception. CD4/CD8 ratio (baseline value 0.570) increased significantly between the first and third trimesters, particularly in women who started ART in pregnancy (+\u20090.163, vs.\u2009+\u20090.036 in women already on treatment). The rate of CD4/CD8 ratio normalization, defined by achieving a ratio\u2009≥\u20091 at the third trimester, was 13.2%. In multivariable analyses, women who entered pregnancy with a CD4/CD8 ratio\u2009<\u20090.3, compared to women with ratio\u2009≥\u20091, were almost four-times less likely to have third-trimester HIV-RNA\u2009<\u200950 copies/ml (AOR 0.258, 95%CI 0.111–0.601), and more than twice as likely to have preterm delivery (AOR 2.379, 95%CI 1.082–5.232). For preterm delivery, also a baseline CD4/CD8 ratio between 0.3 and 0.45 was significantly associated with an increased risk (AOR: 3.415, 95%CI 1.690–6.900). We described for the first time independent associations of low CD4/CD8 ratio with preterm delivery and HIV-RNA suppression.